Knee Osteoarthritis Pain Research Articles

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

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

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis.

To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA). Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries. This review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes. KOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.

Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review.

Musculoskeletal embolization has emerged in recent years as a treatment for chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have demonstrated a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity, to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well-established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intra-articular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most heavily studied musucloskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis. GAE is now supported by multiple prospective studies, including randomized control trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial/lateral epicondylitis), hip (osteoarthritis, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee osteoarthritis and chronic shoulder pain.

Sleep Efficiency Mediates the Association Between Neighborhood Disadvantage and Knee Osteoarthritis Pain: Findings from the Understanding Pain and Limitations in Osteoarthritic Disease Study 2.

The objective was to examine potential pathways linking neighborhood disadvantage to pain severity in individuals with knee pain consistent with or at risk for Knee Osteoarthritis (KOA). The current investigation is a cross-sectional analysis. Data were collected from 140 mid-to older non-Hispanic White and non-Hispanic Black adults from the Understanding Pain and Limitations in Osteoarthritic Disease Study 2 (UPLOAD 2). Relationships among neighborhood disadvantage, sleep efficiency, pain catastrophizing, and pain severity were assessed. Neighborhood disadvantage was quantified using the Area Deprivation Index (ADI) and actigraphy data were used to assess sleep efficiency. The Coping Strategies Questionnaire-Revised catastrophizing subscale and WOMAC (Western Ontario and McMaster Universities Arthritis Index) pain severity scale were used to assess pain catastrophizing, and pain severity, respectively. A serial mediation model assessed the neighborhood➔sleep➔catastrophizing➔pain pathway, as well as neighborhood➔sleep➔pain, and neighborhood➔catastrophizing➔pain pathways. Greater neighborhood disadvantage was associated with worse sleep efficiency, ultimately contributing to greater pain severity. While neither neighborhood disadvantage nor sleep efficiency were associated with pain catastrophizing, pain catastrophizing itself was associated with greater KOA pain. Neighborhood disadvantage impacts KOA pain outcomes through sleep efficiency, but not pain catastrophizing, thereby highlighting environmental aspects that impact sleep as potential targets for intervention.

Efficacy, safety and tolerability of GSK3858279, an anti-CCL17 monoclonal antibody and analgesic, in healthy volunteers and patients with knee osteoarthritis pain: a phase I, randomised, double-blind, placebo-controlled, proof-of-mechanism and proof-of-concept study

ObjectivesThe objective of this study was to evaluate efficacy, safety and tolerability of the first-in-class, anti-CCL17 monoclonal antibody, GSK3858279, in treating knee osteoarthritis (OA) pain.MethodsThis was a phase I, randomised,...

A randomized clinical trial testing digital mindset intervention for knee osteoarthritis pain and activity improvement

This randomized clinical trial evaluated the effectiveness of short, digital interventions in improving physical activity and pain for individuals with knee osteoarthritis. We compared a digital mindset intervention, focusing on adaptive mindsets (e.g., osteoarthritis is manageable), to a digital education intervention and a no-intervention group. 408 participants with knee osteoarthritis completed the study online in the US. The mindset intervention significantly improved mindsets compared to both other groups (P < 0.001) and increased physical activity levels more than the no-intervention group (mean = 28.6 points, P = 0.001), but pain reduction was not significant. The mindset group also showed significantly greater improvements in the perceived need for surgery, self-imposed physical limitations, fear of movement, and self-efficacy than the no-intervention and education groups. This trial demonstrates the effectiveness of brief digital interventions in educating about osteoarthritis and further highlights the additional benefits of improving mindsets to transform patients’ approach to disease management. The study was prospectively registered (ClinicalTrials.gov: NCT05698368, 2023-01-26).

Enhanced joint pain in diabetic patients with knee osteoarthritis is associated with increased synovitis, synovial immune cell infiltration, and erythrocyte extravasation.

Diabetes mellitus (DM) is an important risk factor for the development of osteoarthritis (OA), increasing OA progression and OA pain. To gain insight into the underlying mechanisms of how DM exacerbates OA processes and OA pain, this study analyzed histological differences of synovial tissues from non-DM and DM patients with OA and correlated these differences with knee pain severity. Synovial tissue was obtained from 12 non-DM and 10 DM patients with advanced knee OA who underwent total knee arthroplasty. Synovial inflammation was assessed using the Synovitis score developed by Krenn. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess knee pain intensity and disability in OA patients. The number of mast cells, macrophages, nerve fibers, capillaries, larger vessels and erythrocyte extravasation were analyzed microscopically in histological and immunostained synovial sections from non-DM and DM patients. Association analyses were performed to determine associations between OA knee pain and synovial changes affected by DM. Synovial tissue from OA patients with DM had a higher synovitis score, more erythrocyte extravasation, and contained higher numbers of mast cells and macrophages compared to non-DM patients. The number of capillaries and vessels in the lining/sublining layer of the synovial tissue was reduced in DM patients. OA patients with DM had more severe knee pain compared to non-DM patients. The KOOS pain score was associated with the synovitis score, the number of tissue macrophages, and the number of mast cells in the synovial tissue (adjusted for age, sex, and BMI). In addition, the erythrocyte extravasation score was associated with the KOOS pain score and with the synovitis score. The study suggests that increased OA progression and pain severity in patients with DM result from more pronounced synovitis and synovial vascular leakage and increased infiltration of macrophages and mast cells.

Impact of core muscle strengthening on knee pain, patient outcomes, physical function, and cartilage thickness in knee osteoarthritis: Protocol for a randomized controlled trial

Knee Osteoarthritis (KOA) is a degenerative condition that significantly impacts individuals, causing disability. Routine rehabilitation methods primarily involve knee and hip strengthening exercises. While there is limited evidence supporting the potential benefits of core muscle strengthening in KOA rehabilitation, further research is needed to examine the effects of a structured core muscle strengthening protocol on pain, functional abilities, quality of life, and knee cartilage health. This double-blind, randomized controlled trial seeks to investigate the impact of integrating core muscle strengthening into routine rehabilitation. The study will randomly assign 80 participants to either routine rehabilitation or experimental groups, with both groups receiving routine rehabilitation combined with core strengthening exercises in the experimental group over a twelve-week period. The outcomes measured will include pain levels, patient-reported outcomes, physical functional abilities, core muscle and leg muscle strength, and cartilage height of the femur and tibia. Follow-up assessments will occur in the 4th, 8th, and 12th weeks. This novel study aims to provide valuable insights into the role of core strengthening in KOA rehabilitation, potentially influencing rehabilitation approaches and managing disease progression.•Incorporating core muscle strengthening into routine rehabilitation for KOA could open new possibilities for KOA management.•This study employs outcome measures recommended by OARSI for a thorough evaluation.•Additionally, it will investigate the impact on cartilage health, offering fresh insights into disease progression and the effects of exercise

Effects of increasing walking cadence on gait biomechanics in adults with knee osteoarthritis

Gait retraining is a strategy to manage altered loading patterns and pain characteristic of knee osteoarthritis. Lower walking cadence is associated with higher knee joint loading, vertical ground reaction forces, and risk for cartilage worsening. Therefore, we determined the acute effects of increasing walking cadence on measures of lower extremity loading and knee pain in knee osteoarthritis. Twenty-five participants with knee osteoarthritis (age = 62.5 ± 7.2; 76.0 % female) walked at fixed speed on an instrumented treadmill from which baseline cadence was measured. Five, randomized experimental cadence conditions (2 %, 4 %, 6 %, 8 %, or 10 % over baseline cadence) were completed. Real-time auditory and visual feedback on cadence was provided while kinematics and ground reaction forces were sampled. Linear mixed effects models evaluated the effect of cadence on knee adduction and flexion moment peaks and impulses, impact loading metrics (vertical ground reaction force impact peak, vertical average and instantaneous loading rates), and knee pain. Increasing cadence by 2–10 % did not significantly change knee adduction moment peaks or impulse. Peak knee flexion moment increased by 3–32 % and knee flexion moment impulse reduced by 2–9 % with increases in cadence, but these results were not significant (peak knee flexion moment, p = 0.070; knee flexion moment impulse, p = 0.085). Increasing cadence significantly increased the vertical impact peak (p < 0.001), and the vertical average (p = 0.010), and instantaneous (p = 0.007) loading rates. Small increases in cadence at a fixed gait speed does not significantly change surrogate measures of knee joint loading or pain, but does increase measures of impact loading.

Influence of Knee Osteoarthritis Severity, Knee Pain, and Depression on Physical Function: A Cross-Sectional Study.

Decreased physical function with increasing life expectancy is a public health concern worldwide. Knee osteoarthritis (KOA) is considered one of the primary illnesses causing decreased physical function. Depression affects decreased physical function and is closely related to knee pain in KOA. However, the effect of these interacting factors on physical function is not clear. We conducted a cross-sectional analysis of the baseline data of 1106 subjects of the 2009 Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). We determined the association between their Timed Up and Go test (TUG) scores and radiographic KOA, knee pain, and depression in a multivariate analysis. Severe knee pain was significantly associated with decreased physical function (the odds ratio [OR] was 2.13, 95% confidence interval [CI]: 1.32-4.89), as was depression (OR 2.64, 95% CI 1.61-4.33). Only Kellgren-Lawrence (KL) grade 4 was significantly associated with decreased physical function in the radiographic KOA severity (OR 6.58, 95% CI 1.75-24.68). Severe knee pain and depression were significantly associated with decreased physical function, but not radiographic KOA severity except for KL grade 4. The limitations of using radiographic KOA severity alone as the indicator of assessment for physical function were suggested. When assessing decreased physical function, the clinical focus tends to be on radiographic KOA severity, but it is important to consider the patient's knee pain and psychological factors.

Genicular Nerve Block for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

Genicular nerve block (GNB) has emerged as a novel nonsurgical therapy for symptomatic knee osteoarthritis (KOA). The objective was to evaluate GNB versus placebo and other intra-articular (IA) therapies. The Medline, Embase, and Scopus databases were searched from their inception to January 2021. Only randomized controlled trials (RCTs) were included. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I2 index. Regarding pain statistically significant scores were demonstrated at 1 and 3 months overall total effect of 1.43 (95% CI, 0.86, 1.99; P= 0.00001; I2 =85%). Similarly, for knee function a total effect of 0.71 (95% CI, 0.35, 1.06; P= 0.00001; I2 =69%) at 1 and 3 months, statistically significant. The minimal clinically important difference regarding pain was achieved at 1 and 3 months. Although, GNB achieved the MCID for KOA pain and statistically significant results for knee functions. We cannot recommend its routine use besides being a safe procedure so far, evidence is fair on GNB for primary KOA due to study heterogeneity and limited follow-up.

Topical Nigella Sativa oil versus diclofenac gel for knee osteoarthritis: A randomized open-labeled active-controlled clinical trial

Osteoarthritis (OA) is the most common cause of pain and disability among older adults. This study aims to compare the effect of topical use of Nigella Sativa (NS) oil and diclofenac gel on pain and function in knee OA (KOA). This randomized clinical trial was performed in a rheumatology clinic. Patients who fulfilled the American College of Rheumatology criteria for OA were selected. The subjects were randomly assigned to apply NS oil or diclofenac gel on the knee joint 4 times a day for 3 weeks. The outcomes, including pain and physical activity, were measured with a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the initial 200 KOA patients who were assessed for eligibility, data from 60 patients (30 in each group) were analyzed. The two groups had no significant difference regarding age, sex, and body mass index. Both interventions showed statistically significant within-group differences in terms of the WOMAC subscales of pain, stiffness, function and VAS of pain (P &lt; 0.001). However, there was no significant difference between the groups. Our findings suggested that topical use of NS oil could be as effective as diclofenac gel in reducing pain and stiffness and improving function in KOA.

Factors affecting the therapeutic effects of multiple intra-articular injections of platelet-rich-plasma for knee osteoarthritis

BackgroundPlatelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I). MethodsThis is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added. ResultsAge, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy. ConclusionsAge, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA. Trial registrationRetrospectively registration.

Could ASA and Charlson Comorbidity Index Scores Help the Current Comorbidities Stratification in Non-surgical Knee Osteoarthritis Multimodal Pain Management?

Non-surgical management of knee osteoarthritis emphasizes on multimodal approach according to patients subphenotypes (with or without comorbidities). Surgical treatment outcomes data suggest the role of ASA and Charlson Comorbidity Index (CCI) scores in the field. There are no comparative data on ASA and CCI stratification in non-surgical knee osteoarthritis pain management, which is the aim of our study. Eighty ASA 1–3 in-hospital patients, aged ≥ 36, treated for symptomatic chronic knee osteoarthritis with implemented intra-articular Betamethasone (7 mg/ml) or Hyaluronic acid (30 mg/2 ml), followed by as needed Dexketoprofen 50 mg i.v. or Paracetamol 1.0 g i.v., along with recommended 2 weeks (10 working days) exercise-based physiotherapy programme were examined retrospectively. Data regarding demographics, comorbidities, ASA low-risk(1–2)/high-risk(3), CCI low-risk(0–1/0–2)/high-risk(≥ 2/≥ 3) scoring subgroups, effusions, WBC, ESR, vital signs, clinical laboratory parameters, adverse events, and analgesic consumptions were collected as well. We tested the effect of different ASA and CCI scores on analgesic consumption (primary outcomes), and the effect of implemented risk-adjusted multimodal analgesia on subsequent participation or non-participation in the physiotherapy programme (secondary outcomes). Among all outcomes variables, ASA and CCI stratification confirmed only the higher age and ESR determinants in both the high-risk ASA 3 and high-risk CCI $ ≥ 2 subgroups, as well as more Hyaluronic acid applications in the elderly. The participants in the physiotherapy programme were mainly low-risk patients who received significantly more intra-articular Hyaluronic acid than Betamethasone. The ASA and CCI scores could help current (yes/no comorbidities) decision-making by implementing risk-adjusted pain management, emphasizing on severity rather than the type of comorbid conditions in non-surgical knee osteoarthritis population.

Systematic narrative review of modalities in physiotherapy for managing pain in hip and knee osteoarthritis: A review.

Osteoarthritis (OA) affects 528 million individuals globally, predominantly in knee and hip joints, with a notable impact on females aged over 55, resulting in a substantial economic burden. However, the efficacy of modalities used in physiotherapy to manage OA pain for reducing the need for joint replacement remains an open question, and guidelines differ. Our systematic narrative review, drawing from reputable databases (e.g., PubMed, Cochrane, and CINAHL) with specific Mesh terms investigated evidence from 23 Randomized Controlled Trials (that included a control or a sham group in 30 different protocols) using therapeutic modalities like ultrasound, diathermy, and electrical stimulation for knee and hip OA pain, involving a total of 1055 subjects. We investigated the attainment of minimal clinically important differences in pain reduction, operationalized through a 20% decrement in the Western Ontario and McMaster University Arthritis Index or Visual Analog Scale (VAS) score. Our results indicated that 15 protocols out of 30 reach that level, but there were no statistical differences among modalities. Half of the protocol presented in the literature reached clinical efficiency but studies on hip remains scarce. We recommend a comprehensive, sequential, and multimodal intervention plan for individuals with joint OA with initial transcutaneous electrical nerve stimulation and progressing to a 2-week protocol of continuous ultrasound, potentially combined with deep microwave diathermy. Long-term intervention involves the use of pulsed electrical stimulation. For hip OA, a cautious approach and discussions with healthcare providers about potential benefits of spinal cord nerve stimulation.

Current Evidence on and Clinical Implications of Vitamin D Levels in Pain and Functional Management of Knee Osteoarthritis: A Systematic Review.

Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D deficiency can affect knee osteoarthritis progression. While the exact link between vitamin D and osteoarthritis is still being studied, recent research indicates that low vitamin D levels might influence the articular cartilage's structure and function, potentially accelerating osteoarthritis. This review aims to analyze the last decade of research on vitamin D's role in osteoarthritis. A systematic review of the literature was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Relevant studies from the last ten years were included to evaluate the association between vitamin D levels and knee osteoarthritis. The inclusion criteria were studies examining the role of vitamin D in cartilage health and osteoarthritis progression and the potential clinical implications for disease management. This review identified a variety of studies exploring the connection between vitamin D and osteoarthritis, with mixed findings. The relationship between vitamin D and knee osteoarthritis remains inconclusive, highlighting the need for further research. An updated evaluation of the literature is crucial for osteoarthritis management strategies and to potentially include vitamin D supplementation in therapeutic protocols.

Early gait analysis after total knee arthroplasty based on artificial intelligence dynamic image recognition

To explore early postoperative gait characteristics and clinical outcomes after total knee arthroplasty (TKA). From February 2023 to July 2023, 26 patients with unilateral knee osteoarthritis (KOA) were treated with TKA, including 4 males and 22 females, aged from 57 to 85 years old with an average of (67.58±6.49) years old;body mass index (BMI) ranged from 18.83 to 38.28 kg·m-2 with an average of (26.43±4.15) kg·m-2;14 patients on the left side, 12 patients on the right side;according to Kellgren-Lawrence(K-L) classification, 6 patients with grade Ⅲ and 20 patients with grade IV;the courses of disease ranged from 1 to 14 years with an average of (5.54±3.29) years. Images and videos of standing up and walking, walking side shot, squatting and supine kneeling were taken with smart phones before operation and 6 weeks after operation. The human posture estimation framework OpenPose were used to analyze stride frequency, step length, step length, step speed, active knee knee bending angle, stride length, double support phase time, as well as maximum hip flexion angle and maximum knee bending angle on squatting position. Western Ontario and McMaster Universities (WOMAC) arthritis index and Knee Society Score (KSS) were used to evaluate clinical efficacy of knee joint. All patients were followed up for 5 to 7 weeks with an average of (6.00±0.57) weeks. The total score of WOMAC decreased from (64.85±11.54) before operation to (45.81±7.91) at 6 weeks after operation (P<0.001). The total KSS was increased from (101.19±9.58) before operation to (125.50±10.32) at 6 weeks after operation (P<0.001). The gait speed, stride frequency and stride length of the affected side before operation were (0.32±0.10) m·s-1, (96.35±24.18) steps·min-1, (0.72±0.14) m, respectively;and increased to (0.48±0.11) m·s-1, (104.20±22.53) steps·min-1, (0.79±0.10) m at 6 weeks after operation (P<0.05). The lower limb support time and active knee bending angle decreased from (0.31±0.38) s and (125.21±11.64) ° before operation to (0.11±0.04) s and (120.01±13.35) ° at 6 weeks after operation (P<0.05). Eleven patients could able to complete squat before operation, 13 patients could able to complete at 6 weeks after operation, and 9 patients could able to complete both before operation and 6 weeks after operation. In 9 patients, the maximum bending angle of crouching position was increased from 76.29° to 124.11° before operation to 91.35° to 134.12° at 6 weeks after operation, and the maximum bending angle of hip was increased from 103.70° to 147.25° before operation to 118.61° to 149.48° at 6 weeks after operation. Gait analysis technology based on artificial intelligence image recognition is a safe and effective method to quantitatively identify the changes of patients' gait. Knee pain of KOA was relieved and the function was improved, the supporting ability of the affected limb was improved after TKA, and the patient's stride frequency, stride length and stride speed were improved, and the overall movement rhythm of both lower limbs are more coordinated.

The Success of Treatment for Osteoarthritis with a Genicular Nerve Block is Associated with Patients’ Body Mass Index

Background: While the mainstay of treatment for severe osteoarthritis of the knee has been total knee arthroplasty, a prognostic genicular nerve block (GNB) followed by cooled radiofrequency ablation (CRFA) has been shown to provide long term relief of osteoarthritic knee pain and its disability. The goal of this study is to determine if there is a difference in the demographic makeup of those who had a successful prognostic genicular nerve block compared to those who did not. Methods: A retrospective chart review of 224 genicular nerve blocks was completed. The nerve block was considered successful if the patient reported a 50% or greater pain reduction for a week or more at follow up. Demographic cohorts that were compared include sex, age, race, and BMI. Results: Those who were categorized as non-obese, 36 out of 69 (52.2%) had unsuccessful blocks while 33 out of 69 (47.8%) in this BMI category had successful blocks. Of those who were categorized as obese, 25 out of 75 (33.3%) had unsuccessful blocks while 50 out of 75 (66.7%) in this BMI category had successful blocks. Of those who were deemed morbidly obese, 22 out of 75 (29.3%) had unsuccessful blocks while 53 out of 75 (70.7%) in this BMI category had successful blocks. These results were found to be statistically significant with a p-value of .011. Furthermore, GNB success was not found to be significantly impacted by patient age, race, or gender. Conclusions: These findings demonstrate the utility of prognostic genicular nerve blocks in all patients with osteoarthritis of the knee, but, in particular, the obese patient, who experiences a greater chance of pain relief on average.

Changed resting-state connectivity of anterior insular cortex affects subjective pain reduction after knee arthroplasty: A longitudinal study

The mechanism of chronic knee osteoarthritis (OA) pain and postoperative pain due to knee arthroplasty has not been elucidated. This could be involved neuroplasticity in brain connectivity. To clarify the mechanism of chronic knee OA pain and postoperative pain, we examined the relationship between resting-state functional connectivity (rs-FC) and clinical measurements in knee OA before and after knee arthroplasty, focusing on rs-FCs with the anterior insular cortex (aIC) as the key region. Fifteen patients with knee OA underwent resting-state functional magnetic resonance imaging and clinical measurements shortly before and 6 months after knee arthroplasty, and 15 age- and sex-matched control patients underwent an identical protocol. Seed-to-voxel analysis was performed to compare the clinical measurements and changed rs-FCs, using the aIC as a seed region, between the preoperative and postoperative patients, as well as between the operative and control patients. In preoperative patients, rs-FCs of the aIC to the OFC, frontal pole, subcallosal area, and medial frontal cortex increased compared with those of the control patients. The strength of rs-FC between the left aIC and right OFC decreased before and after knee arthroplasty. The decrease in rs-FC between the left aIC and right OFC was associated with decreased subjective pain score. Our study showed a correlation between longitudinally changed rs-FC and clinical measurement before and after knee arthroplasty. Rs-FC between the aIC and OFC have the potential to elucidate the mechanisms of knee OA pain and postoperative pain due to knee arthroplasty.

Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial.

Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions. Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269.