Ontario McMaster Universities Osteoarthritis Index Research Articles

PRISMA-Compliant Meta-Analysis of Randomized Controlled Trials on Osteoarthritis of Knee Managed with Allogeneic vs Autologous MSCs: Efficacy and Safety Analysis.

Meta-analysis. Our objective is to review the randomized controlled trials (RCTs) that have been conducted previously on the topic of osteoarthritis of the knee to assess and compare the efficacy and safety of autologous and allogeneic sources of mesenchymal stromal cells (MSCs) in the treatment of osteoarthritis. We searched the electronic databases PubMed, Embase, Web of Science, and the Cochrane Library until August 2021 for randomised controlled trials (RCTs) analysing the efficacy and safety of autologous and allogeneic sources of MSCs in the management of knee osteoarthritis. These searches were conducted independently and in duplicate. The outcomes that were taken into consideration for analysis were the visual analogue score (VAS) for pain, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), the Lysholm score, and adverse events. The OpenMeta [Analyst] software was utilised to carry out the analysis in the R platform. In total, 21 studies with a total of 936 patients were considered for this analysis. Because none of the studies made a direct comparison of the autologous and allogeneic sources of MSCs, we pooled the results of all of the included studies of both sources and made a comparative analysis of how the two types of MSCs fared in their respective applications. Although both allogeneic and autologous sources of MSCs demonstrated significantly better VAS improvement after 6 months (p = 0.006, p = 0.001), this trend was not maintained after 1 year for the allogeneic source (p = 0.171, p = 0.027). When compared to their respective controls based on WOMAC scores after 1 year, autologous sources (p = 0.016) of MSCs performed better than allogeneic sources (p = 0.186).A similar response was noted between the sources at 2years in their Lysholm scores (p = 0.682, p = 0.017), respectively. Moreover, allogeneic sources (p = 0.039) of MSCs produced significant adverse events than autologous sources (p = 0.556) compared to their controls. Our analysis of literature showed that autologous sources of MSCs stand superior to allogeneic sources of MSC with regard to their consistent efficacy for pain, functional outcomes, and safety. However, we strongly recommend that further studies be conducted that are of a high enough quality to validate our findings and reach a consensus on the best source of MSCs for use in cellular therapy treatments for knee osteoarthritis. The online version contains supplementary material available at 10.1007/s43465-022-00751-z.

Effect of a programme of muscular endurance, balance and gait exercises with and without the use of flexible and minimalist shoes in older women with medial knee osteoarthritis: study protocol for a randomised controlled trial

IntroductionStudies have indicated that gait intervention programmes with minimalist shoes are effective for reducing pain, improving functionality and reducing knee joint overload in older women with knee osteoarthritis (OA). Other...

Efficacy and safety of tanezumab, NSAIDs, and placebo in patients with moderate to severe hip or knee osteoarthritis and a history of depression, anxiety, or insomnia: post-hoc analysis of phase 3 trials

Objective: Treatment outcomes for chronic pain can be poor in patients with depression, anxiety, or insomnia. This analysis evaluated the efficacy and safety of subcutaneous tanezumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and placebo in patients with osteoarthritis (OA) and a history of these conditions using data from three phase 3 studies. Methods: A post-hoc analysis of data from two pooled placebo-controlled studies and one NSAID-controlled study of subcutaneous tanezumab. All patients had moderate to severe knee or hip OA that was inadequately controlled with standard-of-care analgesics. Efficacy outcomes were least-squares mean change from baseline to Week 16 in Western Ontario McMaster Universities OA Index (WOMAC) Pain, WOMAC Physical Function, Patient’s global assessment of OA, and EQ-5D-5L scores. Results were summarized for patients with and without a history of depression, anxiety, or insomnia at baseline. Results: 1545 patients were treated in the pooled placebo-controlled studies (history of depression, 12%; anxiety, 8%; insomnia, 10%; any, 23%) and 2996 in the NSAID-controlled study (16%, 11%, 13%, 28%, respectively). In groups with positive histories, 38–80% took antidepressant or anxiolytic medications at baseline. Within treatments, largely similar improvements in efficacy outcomes were observed in patients with and without a history of depression, anxiety, or insomnia; the types of treatment-emergent adverse events were similar. Conclusions: Patients with OA and a history of depression, anxiety, or insomnia did not appear to experience reduced efficacy outcomes or an altered safety profile in response to tanezumab or NSAID treatment as compared with those without. NCT02697773; NCT02709486; NCT02528188

The combination of osteoporosis and low lean mass correlates with physical function in end-stage knee osteoarthritis: A retrospective observational study.

We aimed to investigate the prevalence of osteoporosis and low lean mass, either together or in isolation, and their association with physical function, pain, and quality of life (QOL) in patients with end-stage knee osteoarthritis (OA).This retrospective cross-sectional observational study included 578 patients (77 males and 501 females) diagnosed with end-stage knee OA. Patients were divided into 4 groups based on body composition parameters: control, osteoporosis, low lean mass, and osteoporosis + low lean mass. All participants underwent performance-based physical function tests, including a stair climbing test (SCT), a 6-minute walk test, a timed up and go test, and instrumental gait analysis, to examine spatiotemporal parameters. Self-reported physical function and pain levels were measured using the Western Ontario McMaster Universities Osteoarthritis Index and visual analog scale, respectively. Self-reported QOL was measured using the EuroQOL 5 dimensions (EQ-5D) questionnaire.Of 578 patients, 268 (46.4%) were included in the control group, 148 (25.6%) in the osteoporosis group, 106 (18.3%) in the low lean mass group, and 56 (9.7%) in the osteoporosis + low lean mass group. Analysis of variance revealed that the scores for the osteoporosis + low lean mass group in the SCT-ascent, SCT-descent, and timed up and go test were significantly higher, whereas those for the 6-minute walk test, gait speed, and cadence were significantly lower than those for the other groups (P < .05). After adjusting for age, sex, and body mass index, multiple linear regression analysis identified SCT-ascent (β = 0.140, P = .001, R2 = 0.126), SCT-descent (β = 0.182, P < .001, R2 = 0.124), gait speed (β = –0.116, P = .005, R2 = 0.079), and cadence (β = –0.093, P = .026, R2 = 0.031) as being significantly associated with osteoporosis + low lean mass.Thus, osteoporosis + low lean mass correlates with poor physical function, but not pain and QOL, in patients with end-stage knee OA.

The Efficacy of Pulsed Electromagnetic Fields on Pain, Stiffness, and Physical Function in Osteoarthritis: A Systematic Review and Meta-Analysis.

Background Although there are many pharmacological interventions for adults with osteoarthritis (OA) who do not meet the indications for surgery, side effects and adverse effects cannot be ignored. Physical interventions are known for their effectiveness and safety, and pulsed electromagnetic fields (PEMFs) have already been applied to skeletal diseases such as osteoporosis. Objective In this systematic review and meta-analysis, we aimed to assess the efficacy of PEMF on the major symptoms of patients with OA compared with efficacy of other interventions. Methods Randomized controlled trials (RCTs) investigating OA patients treated with PEMF and with pain, stiffness, and physical function impairment since 2009 were included. The Visual Analog Scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were used for assessment. All extracted data were analyzed using RevMan V.5.3. Results Eleven RCTs consisting of 614 patients were enrolled in this meta-analysis, of which 10 trials comprised knee OA and one comprised hand OA. Compared with the control groups, the PEMF treatment yielded a more favorable output. PEMF alleviated pain (standardized mean differences [SMD] = 0.71, 95% confidence interval [CI]: 0.08–1.34, p = 0.03), improved stiffness (SMD = 1.34, 95% CI: 0.45–2.23,p=0.003), and restored physical function (SMD = 1.52, 95% CI: 0.49–2.55,p=0.004). Conclusions PEMF therapy ameliorates OA symptoms such as pain, stiffness, and physical function in patients compared to other conservative treatments. There is an urgent need to search for different types of OA in multiple locations.

Comparison of ultrasound guided pulsed radiofrequency of genicular nerve with local anesthetic and steroid block for management of osteoarthritis knee pain.

BackgroundTo compare ultrasound-guided pulsed radiofrequency (PRF) of the genicular nerve with the genicular nerve block using local anesthetic and steroid for management of osteoarthritis (OA) knee pain.MethodsThirty patients with OA knee were randomly allocated to receive either ultrasound-guided PRF of the genicular nerve (PRF group) or nerve block with bupivacaine and methylprednisolone acetate (local anesthetic steroid [LAS] group). Verbal numeric rating scale (VNRS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were measured at pre-procedure and 1-, 4-, and 12-weeks post-procedure.ResultsVNRS scores decreased significantly (P < 0.001) in both the groups at 12 weeks and other follow up times compared to baseline. Seventy-three percent of patients in the PRF group and 66% in the LAS group achieved effective pain relief (≥ 50% pain reduction) at 12 weeks (P > 0.999). There was also a statistically significant (P < 0.001) improvement in WOMAC scores in both groups at all follow up times. However, there was no intergroup difference in VNRS (P = 0.893) and WOMAC scores (P = 0.983). No complications were reported.ConclusionsBoth ultrasound-guided PRF of the genicular nerve and blocks of genicular nerve with local anesthetic and a steroid provided comparable pain relief without any complications. However, PRF of the genicular nerve is a procedure that takes much more time and equipment than the genicular nerve block.

Effects of Low Level Laser Therapy on Knee Pain and Functional Status among Patients with Knee Osteoarthritis

Objective: To determine the outcomes of low level laser therapy on knee pain and functional status among patients with knee osteoarthritis. Methodology: A randomized controlled trial was conducted in physiotherapy department of Allied Hospital Faisalabad. Thirty four patients were randomly divided into experimental group treated with low level laser therapy combined with conventional exercises and control group treated with conventional exercises only. Numeric Pain Rating Scale, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and goniometer were used as data collection tools. All the patients received 9 treatment sessions, 3 sessions per week for 3 weeks.

Irrigation and debridement for knee osteoarthritis patients with suspected infection by intra-articular injection before total knee arthroplasty: a retrospective study

BackgroundPatients suffer from knee osteoarthritis (KOA) pain may seek for intra-articular injections before total knee arthroplasty (TKA), which have a possibility of causing the joint sepsis. However, the management and clinical outcomes of these patients following TKA remain uncertain.MethodsPatients with a history of intra-articular injection, in which a joint sepsis was suspected, were included. The patients received joint irrigation and debridement (I&D) and antibiotic treatment until serum inflammatory indicators returned to normal level before TKA. The information of joint fluid routine and culture, synovium section and culture, and serum inflammatory indicator values were collected. Range of motion, Knee Society Scores (KSS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) were used for functional evaluations.ResultsA total of 17 patients with 17 knee joints were included, all with elevated C-reactive protein (CRP) levels (23.5 ± 8.7 mg/L) as well as increased number of white blood cells (WBC) in the aspiration (50.8 ± 15.3) × 109/L, but no positive cultures were found. The culture of synovium detected three positive results: two Staphylococcus epidermidis and one S. aureus. I&D treatment had no obvious effect on the functional outcomes of KOA, but alleviated the joint pain (p < 0.01). Furthermore, we found that I&D pretreatment could increase the operation time with about 10 min longer than the primary TKA (p < 0.01). With respect to TKA outcomes, I&D had a slight influence on the knee flexion (p < 0.01), but no significant difference was identified between the two groups for KSS and WOMAC (all p values > 0.05). In addition, there was no significant difference in complication rates between the two groups in the last follow-up.ConclusionI&D treatment is a valuable procedure for suspected knee infection, which has a higher incidence of detecting microorganisms while does not influence the functional outcomes and complication rates of TKA. However, further larger studies are required to confirm these findings.

Number of falls in elderlies and adults with knee osteoarthritis (KOA)

<h3>Research Objectives</h3> to identify the number of falls in elderlies and adults with KOA; to analyze the perception of imbalance or knee instability; and to evaluate de function impairment of these patients. <h3>Design</h3> A cross-section survey study where patients with KOA answered a questionnaire about socioeconomic, number of falls, perception of imbalance or knee instability and function impairment analyzed by "Western Ontario McMaster Universities Osteoarthritis Index" (WOMAC). <h3>Setting</h3> General community of Macapá-AP, Brazil. <h3>Participants</h3> Eighteen KOA patients, from general community of Macapá-AP, Brazil, with 18 years or older have answered the questionnaire between March and June 2021. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Number of falls in the last 6 months, function impairment and perception of imbalance or knee instability. <h3>Results</h3> Data were collected from 18 subjects with KOA. There were 9 elderlies with a mean age of 72.2 years (±8.6) and 9 adults with a mean age of 41.1 years (±9.1). From this sample 44.4% of adults and 88.9% of elderlies with KOA reported episodes of falls. About perception of imbalance or knee instability, 77.8% of adults described have imbalance or knee instability, while 100% of elderlies have this perception. Adults with KOA had a score of function impairment of 30 (±13.5) and elderlies with 33.62 (±16.6) on the WOMAC function subscale (0-68 points), where higher scores indicate better physical function <h3>Conclusions</h3> Adults with KOA have a relevant percentage of falls and perception of imbalance or knee instability, and similar function impairment when compared with elderlies with KOA, showing that OA could be impairing knee joint proprioception and reducing balance and activities of daily living even in earlier ages with KOA. <h3>Author(s) Disclosures</h3> The authors declared no conflict of interest.

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment - A prospective randomized and multicenter study.

BackgroundThe objective of this study was to compare the radiologic and clinical outcomes of HURWA robotic-assisted total knee arthroplasty (TKA) to those of conventional TKA.MethodsA total of 150 patients were randomized into two groups – 73 and 77 patients underwent robotic-assisted TKA and conventional TKA, respectively. Preoperative and postoperative Western Ontario McMaster University Osteoarthritis Index (WOMAC) score, Hospital for Special Surgery (HSS) score, 36-item Short Form Health Survey (SF-36) score, Knee Society Score (KSS) and range of motion (ROM) were obtained and compared between these two groups. The preoperative and postoperative hip-knee-ankle (HKA) angle and the rate of HKA≤3° in the two groups were also compared.ResultsThe postoperative mean HKA angle was 1.801° ​± ​1.608° of varus for the robotic-assisted TKA group and 3.017° ​± ​2.735° of varus for the conventional TKA group; these values were significantly different. The alignment rate for mechanical axis lower than 3° in the robotic-assisted TKA group and the conventional TKA group were 81.2% and 63.5%, respectively. Patients undergone robotic-assisted TKA or conventional TKA had similarly improved knee flexion and functional recovery reflected by WOMAC score, HSS score, SF-36 score and KSS.ConclusionHURWA robotic-assisted TKA is a safe and effective, resulting in better alignment for mechanical axis than conventional TKA. The improvement in knee flexion and functional recovery after HURWA robotic-assisted TKA were similar to those after conventional TKA. However, longer follow-up is needed to determine whether the improved alignment of mechanical axis will produce better long-term clinical outcomes.The translational potential of this articleRecently, the robotic-assisted TKA system has been introduced to clinical practice for TKA. Several robotic-assisted TKA systems, including CASPAR, Tsolution, ROSA, ROBODOC and Mako, have been implemented into clinical application.However, the clinical application of these robotic systems was limited due to their technical complexity, insufficient versatility and increased operative time. Until now, there are still no robotic-assisted TKA systems approved by the National Medical Products Administration of China. Therefore, more robotic-assisted TKA systems need to be designed and improved, particularly in China. Through our randomized, multicenter, single blind and parallel controlled trial, we showed that HURWA robot-assisted TKA system is a safe and effective system for TKA, which had improved knee flexion.

Effectiveness of Structured Rehabilitation Program on Pain and Function in Patients with Total Knee Replacement: A Randomized Controlled Trial

Objective: To determine the effectiveness of the structured rehabilitation program on knee pain and function in patients with a total knee replacement. Methodology: A randomized controlled trial conducted at Horizon Hospital Lahore. Twenty six patients were randomly allocated to experimental and control group. Experimental group was treated with structured rehabilitation program and conventional exercises while control group was treated with conventional exercises alone. Outcome measuring tools were numeric pain rating scale, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and goniometer. All the patients received 16 sessions of treatment. Data was collected at baseline and at the end of 4th week. Results: Outcome measures numeric pain rating scale, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and goniometer showed significant results (p&lt;0.05) after treatment in both groups but mean values showed more improvement in experimental group treated with structured rehabilitation program. Conclusion: This study concluded that structured rehabilitation program had better effects on pain, function and range of motion in patients with knee arthroplasty. Keywords: Arthroplasty, Replacement, Knee, Knee osteoarthritis, Range of motion, exercise therapy

Identification of early response to hypertonic dextrose prolotherapy markers in knee osteoarthritis patients by an inflammation-related cytokine array.

Osteoarthritis (OA) is one of the most common forms of arthritis, and hypertonic dextrose prolotherapy has long been used clinically to treat knee OA. The aim of this study was to investigate the inflammation-related protein-expression profile characterizing the efficacy of the hypertonic dextrose prolotherapy in knee OA as prognostic markers. OA patients over the age of 65 were recruited for Western Ontario McMaster University Osteoarthritis (WOMAC) index, knee X-ray evaluation and knee joint synovial fluid analysis before and after hypertonic dextrose prolotherapy. The expressions of inflammation-related factors were measured using a novel cytokine antibody array methodology. The cytokine levels were quantified by quantitative protein expression and analyzed by ELISA using the patients' knee-joint synovial fluid. The WOMAC Index and minimum joint space width before receiving the intra-articular injection and at 2-week intervals were compared. Twelve patients who received OA intervention were enrolled and finally a clinical evaluation of 12 knee joints and knee synovial fluid samples were analyzed. In this study, after receiving hypertonic dextrose prolotherapy, the OA patients clearly demonstrated a significant improvement in WOMAC index and increasing tendency in the medial minimum joint space width after intervention. Meanwhile, we observed a significantly associated tendency between hypertonic dextrose treatment of knee OA and the upregulation of MMP2, TIMP-1, EGF, CXCL9 and IL-22. The findings provide knee OA patients receiving hypertonic dextrose prolotherapy, which is accompained by the improvemeny of knee symptoms and associated tendency of upregulation of MMP2, EGF, CXCL 9 and IL-22.

Efficacy of neural prolotherapy versus local corticosteroid soft tissue injection for treatment of chronic anserine bursitis: a prospective randomized clinical trial

BackgroundAnserine bursitis is characterized by the presence of spontaneous pain with tenderness at the inferomedial aspect of the knee joint. Neural prolotherapy aims to relieve pain of a variety of chronic musculoskeletal disorders. The study aim was to explore the short-term efficacy of neural prolotherapy (subcutaneous perineural injection of dextrose 5% solution) versus local corticosteroid injection for pain relief and improvement of function in patients with chronic anserine bursitis. The enrolled patients were randomly assigned to receive neural prolotherapy (subcutaneous perineural injection of dextrose 5% solution) (neural prolotherapy group) or a single local soft tissue injection of corticosteroid (corticosteroid group). Outcome measures included Western Ontario McMasters Universities osteoarthritis index, assessment of overall anserine bursitis pain severity using the visual analogue scale, patient’s global assessment of anserine bursitis severity using the visual analogue scale, and clinical assessment for the presence of tenderness on the anserine bursa region. Patients were evaluated before injection and after intervention by 4 weeks.ResultsThe study included 67 lower limbs from 43 patients with chronic anserine bursitis. No significant differences were found between both treatment groups regarding all assessed parameters at the start of the study. After 4 weeks, within-group analysis showed that there was a statistically significant improvement in Western Ontario McMasters Universities osteoarthritis index and its subscales (P ≤ 0.0001), overall anserine bursitis pain severity (P ≤ 0.0001), and patient’s global assessment of anserine bursitis severity (P ≤ 0.0001), as well as there was significant improvement regarding the presence of tenderness at the anserine bursa region in both groups in comparison to the preinjection assessment. At the postinjection assessment, between-group analysis showed that there were no significant differences regarding all assessed outcome parameters. All patients in both groups tolerated the injection procedure and were satisfied with the procedure. There was no significant difference between the two groups regarding patients’ satisfaction to the procedure results. Improvement was achieved in 86.4% of patients included in the neural prolotherapy group versus 95.2% of patients included in the corticosteroid group.ConclusionsNeural prolotherapy was effective in relieving pain, improving local tenderness and function in patients with chronic anserine bursitis similar to local corticosteroid injection.Trial registrationClinicalTrials.gov, registration number: NCT04509440. Registered 12 August 2020—Retrospectively registered,

Makoplasty medial unicondylar knee replacement: Correction or postoperative angle matters?

Various considerations prevail around optimal postoperative varus deformity, correction angle and physiological constitutional varus deformity. The goal of our present study was to understand correlation between these parameters and their influence over Western Ontario McMaster University Osteoarthritis Index scale (WOMAC). Consecutive robotic-arm-assisted medial onlay fixed bearing unicompartmental knee arthroplasty (UKA) in 143 knees studied. WOMAC score was recorded preoperatively and at specific intervals after surgery for consecutive 2 years. Mean preoperative and postoperative varus deformities were 10.2° and 4.8°, respectively, and mean correction angle was 5.4°. The preoperative varus and correction angles were found well correlated (r=0.815). The amount of improvement in the WOMAC total score was not influenced by the postoperative varus angle. The correction angle has a stronger correlation with preoperative varus deformity, and postoperative varus deformity does not imply favourable clinical outcomes.

Long-term Functional Difference between the First and Second Knees in Simultaneous Bilateral Total Knee Arthroplasty.

To compare the long-term functional results of the first and second knees in simultaneous bilateral total knee arthroplasty. Descriptive study. Gulhane Education and Research Hospital, Ankara, Turkey from January 2003 to December 2010. A total of 47 patients with at least 10 years of follow-up after simultaneous bilateral total knee arthroplasty were included in the study. The range of motion, forgotten joint score (FJS), Oxford knee score (OKS), and Western Ontario McMaster university osteoarthritis index (WOMAC) were compared between the first and the second knees. The Dependent t-test and the Wilcoxon Sign test were used to determine the significance. Whether there was a statistically significant correlation, so Spearman's correlation test and Bonferroni correction were used. WOMAC total scores both knees were 13 (p=0.755). The average OKS of the first operated knees was 40.53 ± 4.44, while it was 40.28 ± 4.59 in the second knees (p=0.239). The FJS of the first and second operated knees were 69.36 ± 21.97 and 69.02 ± 21.89, respectively (p=0.321). As the age increased, the ROM was decreased. As the patient age increased, WOMAC pain scores were found to decrease. The functional scores of the first and the second operated knees in SBTKA were similar in the long term. Although no correlation was found between age and the functional scores, these results complied with the previous information about the effect of age on TKA results. Key Words: Simultaneous total knee arthroplasty, Bilateral, Clinical outcome, Osteoarthritis.

The Efficacy of Harpagophytum procumbens (Teltonal) in Patients with Knee Osteoarthritis: A Randomized Active-Controlled Clinical Trial.

Purpose The high prevalence of knee osteoarthritis (KOA) is a major cause of disability among elders. NSAIDs are recommended to reduce KOA patients' symptoms, but their adverse side effects limit their consumption. In this study, we evaluated the effectiveness of Harpagophytum procumbens compared to a routine NSAID (meloxicam) on pain reduction and functional improvement of KOA patients. Patients and Methods. Sixty patients aged 40–60 years, with painful knee osteoarthritis (grades 1-2 of Kellgren–Lawrence scale) for at least one month, were randomized into two groups with different routine medication periods. Group A consisted of daily administration of two Harpagophytum procumbens (Teltonal) tablets (2∗480 mg) for one month, and group B consisted of daily administration of meloxicam (15 mg) for ten days. The visual analogue scale (VAS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), Oxford Knee Scale (OKS), and patient satisfaction were evaluated at the baseline and after 2, 4, and 8 weeks. Results There were no statistically significant differences between demographic characteristics, pain intensity, and function scores before the treatment. VAS, OKS, and WOMAC scores improved in both groups (p < 0.001) over time, but no significant superiority was shown; after 8 weeks: VAS (Teltonal (4.80 ± 1.80) vs. meloxicam (5.06 ± 1.43)), OKS (34.06 ± 4.38, 34.00 ± 7.87, Teltonal vs. meloxicam, respectively), and WOMAC scores (25.73 ± 10.11 Teltonal vs. 26.20 ± 13.94, meloxicam). Conclusion Teltonal is an effective and safe treatment in patients with mild KOA in the short term. However, no significant superiority was shown in using Teltonal or meloxicam, in people who cannot take NSAIDs, it can be a good alternative, although difference in medication periods should be considered.

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

BackgroundAim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up.Materials and methodsWe retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery.ResultsOur study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up.ConclusionsOur study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up.

The Efficacy of Ozone Prolotherapy Compared to Intra-Articular Hypertonic Saline Injection in Reducing Pain and Improving the Function of Patients with Knee Osteoarthritis: A Randomized Clinical Trial

Background Knee osteoarthritis is a common disease that is associated with chronic pain and disability in patients. Prolotherapy is a complementary therapeutic approach for improving pain and function in patients with osteoarthritis. We aimed to compare the effect of hypertonic saline with ozone plus hypertonic saline in improving the symptoms of osteoarthritis in the patients. Materials and Method. In this clinical trial, thirty-four adults with painful primary knee osteoarthritis for at least three months were randomized to two groups: ozone plus hypertonic saline 5% and hypertonic saline 5% alone. Prolotherapy and thrice follow-up with two-week intervals were done. The outcome measures included Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS), which were obtained from the patients before the injection and after the 2nd and 4th weeks after the start of the study. Results The mean age of the participants was 60.12 ± 7.54 years. There were no statistically significant differences between demographic characteristics before the injection between the two groups (p > 0.05). The results showed that VAS and OKS values decreased over time (p < 0.001) in each group, but there was no significant difference in the reduction of those between the two treatment groups (p = 0.734 and p = 0.734, respectively). Both interventions improved the mean values of WOMAC pain, WOMAC stiffness, WOMAC act, and WOMAC total. However, there was no significant difference in WOMAC pain reduction rate (p = 0.465), WOMAC stiffness rate (p = 0.656), WOMAC act rate (p = 0.376), and WOMAC total rate between the two methods (p = 0.528). Conclusion The results showed that intra-articular prolozone therapy and hypertonic saline injection can lead to improvement of pain and function in patients with knee osteoarthritis at the same status without any significant difference.

Evaluation of the efficacy of gallium-aluminum-arsenide laser acupuncture in the management of knee osteoarthritis

Background/aim Knee osteoarthritis is a common degenerative disease affecting the joint, causing progressive loss of cartilage and inflammation. Its main symptoms are pain and stiffness. Medications such as NSAIDs have little benefit and are usually accompanied by serious adverse effects. The aim of this study was to evaluate the efficiency of laser acupuncture in the management of stage 2 or 3 knee osteoarthritis. Patients and methods The study was carried out on 30 patients (24 females and six males) diagnosed as having stage 2 or 3 knee osteoarthritis. The patients were recruited from the Complementary and Alternative Medicine Clinic at the Medical Centre of Excellence, National Research Centre, Cairo, Egypt. The patients were subjected to low-power laser (gallium-aluminum-arsenide 905 nm) with touch sensor guide light, power output of 100 mill watts, beam area of 1 cm2, 1-min irradiation time, frequency 10 000 Hz, duty cycle 100%, total energy per point 6 J, energy density 6 J/cm2, and irradiance 0.1 W/cm2, for 3 days/week for a duration of 4 weeks (12 session), directed at various acupuncture points (ST 35, ST 36, Sp 9, Sp 10, GB 34, Sp 6, and liv3). Clinical and laboratory parameters were assessed before and after laser therapy. Results Pain on visual analog scale, number of tender points, tenderness score, angle of knee flexion, heel to hip distance, Western Ontario McMaster Universities Osteoarthritis Index scale score, and Lequesne Index showed significant improvement after treatment (P&lt;0.05). Timed up and go test result was decreased after laser sessions, but its improvement was insignificant statistically. Significant improvement and increase of enkephalin and immunoglobulin (IL-4) were recorded after treatment. Conclusion Laser acupuncture showed efficacy in the management of stage 2 or 3 knee osteoarthritis.

English

This double-blind experimental study evaluates the efficacy of chondroprotective supplementation (Carticure Plus®, 5000 mg Collagen – Bioactive Peptides, 1500 mg Glucosamine Hydrochloride, 1200 mg Chondroitin Sulfate, 1.1 mg Copper, 80 mg Vitamin C, 2 mg Manganese) in patients with meniscal and ligament pathology who have required arthroscopic surgery. 12 patients with ligamentous injury and 12 patients with meniscopathy were selected, who underwent the measurement of different inflammatory markers using ELISA, collagen 2A and hyaluronic acid, in addition to evaluating pain as well as functionality and quality of life through VAS (Visual Analogue Scale), WOMAC (Western Ontario McMaster Universities Osteoarthritis Index) and KOOS (Knee Injury and Osteoarthritis Outcome Score). Statistically significant differences of clinical improvement were observed in favor of Carticure Plus®, with an improvement in the functional capacity of the WOMAC scale, 76% Carticure Plus® vs 53% placebo, for all patients and with a clear improvement in the first month in meniscal injury, in improvement of the activities of daily life (KOOS), Carticure Plus® 31% vs placebo -1%, sports activity, (Carticure Plus® 41% vs placebo 13,2%) and sports and recreational activities (KOOS) (Carticure Plus® 128% vs Placebo 10,4%). On the other hand, in ligamentous injury an improvement in quality of life (KOOS) Carticure Plus® 75% vs Placebo -8,8% and pain (KOOS) Carticure Plus® 49,6% vs Placebo 0,3% was observed in the first month compared to the baseline. In the patient group, pain (KOOS) Carticure Plus® 31,4% vs Placebo 1,3% and activities of daily living (KOOS) Carticure Plus® 43,9% vs Placebo 27,1% in the third month from baseline, are associated with an improvement due to Carticure Plus® when compared to the placebo group. Despite the small sample size, it is remarkable the fact that statistically significant differences have been found, the efficacy of Carticure Plus® could be assumed.