Reduce Knee Pain Research Articles

Short term results of total knee arthroplasty in tertiary rural tier three government medical college and hospital

<p class="abstract"><strong>Background:</strong> The objective of the study was to assess the clinical and functional outcome of total knee arthroplasty (TKA) using posterior cruciate stabilizing (PS) design in tertiary rural government hospital with limited infrastructure using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and to offer a low cost option and assess post-operative pain relief in rural poor of the society and to compare the WOMAC score pre and post-operatively.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on patients who have undergone primary total knee arthroplasty in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad from December 2018 to December 2019. The patients were assessed using the WOMAC score and X-rays. These evaluations were performed at 3, 6 and 12 months follow up visits.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 1 year follow up of 30 knees, the average pre-op WOMAC score of 79.5 improved to an average post-op score of 42.3. And knee flexion increased from 96.3 degree to 108.5 degrees both of which with a p value <0.0001 are statistically significant. One patient each had wound dehiscence and superficial infection. Patient satisfaction after the procedure was good-both in unilateral and staged bilateral TKA.</p><p class="abstract"><strong>Conclusions:</strong> TKA reduces knee pain significantly and improves the functional ability of the patient. And to be able to do so in a tertiary government rural setup with no laminar airflow and with such great efficacy and minimal complications bodes well for the number of people living in rural areas suffering from knee pain.</p>

Resistance Exercise and Knee Osteoarthritis

Resistance Exercise and Knee Osteoarthritis

Does cartilage loss cause pain in osteoarthritis and if so, how much?

ObjectivesAlthough treatment development in osteoarthritis (OA) focuses on chondroprotection, it is unclear how much preventing cartilage loss reduces joint pain. It is also unclear how nociceptive tissues may be involved.MethodsUsing...

Mulligan Knee Taping Using Both Elastic and Rigid Tape Reduces Pain and Alters Lower Limb Biomechanics in Female Patients With Patellofemoral Pain.

Background:Evidence supports the use of Mulligan knee taping in managing patellofemoral pain (PFP). However, no studies have compared the efficacy of rigid and elastic tape using this technique.Hypothesis:Mulligan knee taping applied with both rigid and elastic tape will produce similar reductions in knee pain, hip internal rotation, and knee flexion moments compared with no tape. Elastic tape will also be more comfortable than rigid tape.Study Design:Controlled laboratory study.Methods:A total of 19 female patients (mean age, 26.5 ± 4.5 years) with PFP performed a self-selected pain provocative task, single-leg squat (SLSq) task, and running task while wearing Mulligan knee taping applied with rigid tape, elastic tape at 100% tension, and no tape. Pain and taping comfort were recorded using 11-point numeric rating scales. An 18-camera motion capture system and in-ground force plates recorded 3-dimensional lower limb kinematics and kinetics for the SLSq and running tasks. Statistical analysis involved a series of repeated-measures analyses of variance. The Wilcoxon signed rank test was used for analyzing taping comfort.Results:Compared with no tape, both rigid and elastic tape significantly reduced pain during the pain provocative task (mean difference [MD], –0.97 [95% CI, –1.57 to –0.38] and –1.42 [95% CI, –2.20 to –0.64], respectively), SLSq (MD, –1.26 [95% CI, –2.23 to –0.30] and –1.13 [95% CI, –2.09 to –0.17], respectively), and running tasks (MD, –1.24 [95% CI, –2.11 to –0.37] and –1.16 [95% CI, –1.86 to –0.46], respectively). Elastic tape was significantly more comfortable than rigid tape generally (P = .005) and during activity (P = .022). Compared with no tape, both rigid and elastic tape produced increased knee internal rotation at initial contact during the running task (MD, 5.5° [95% CI, 3.6° to 7.4°] and 5.9° [95% CI, 3.9° to 7.9°], respectively) and at the commencement of knee flexion during the SLSq task (MD, 5.8° [95% CI, 4.5° to 7.0°] and 5.8° [95% CI, 4.1° to 7.4°], respectively), greater peak knee internal rotation during the running (MD, 1.8° [95% CI, 0.4° to 3.3°] and 2.2° [95% CI, 0.9° to 3.6°], respectively) and SLSq tasks (MD, 3.2° [95% CI, 2.1° to 4.3°] and 3.8° [95% CI, 2.3° to 5.2°], respectively), and decreased knee internal rotation range of motion during the running (MD, –3.6° [95% CI, –6.1° to –1.1°] and –3.7° [95% CI, –6.2° to –1.2°], respectively) and SLSq tasks (MD, –2.5° [95% CI, –3.9° to –1.2°] and –2.0° [95% CI, –3.2° to –0.9°], respectively).Conclusion:Mulligan knee taping with both rigid and elastic tape reduced pain across all 3 tasks and altered tibiofemoral rotation during the SLSq and running tasks.Clinical Relevance:Both taping methods reduced pain and altered lower limb biomechanics. Elastic tape may be chosen clinically for comfort reasons.

Effect of Intravenous Zoledronic Acid on Tibiofemoral Cartilage Volume Among Patients With Knee Osteoarthritis With Bone Marrow Lesions

A proof-of-principle study suggested that intravenous zoledronic acid may reduce knee pain and the size of bone marrow lesions in people with knee osteoarthritis, but data from large trials are lacking. To determine the effects of intravenous zoledronic acid on knee cartilage volume loss in patients with symptomatic knee osteoarthritis and bone marrow lesions. A 24-month multicenter, double-blind placebo-controlled randomized clinical trial conducted at 4 sites in Australia (1 research center and 3 hospitals). Adults aged 50 years or older with symptomatic knee osteoarthritis and subchondral bone marrow lesions detected by magnetic resonance imaging (MRI) were enrolled from November 2013 through September 2015. The final date of follow-up was October 9, 2017. Intravenous infusion with either 5 mg of zoledronic acid in a 100-mL saline solution (n = 113) or a placebo saline solution (n = 110) at baseline and 12 months. The primary outcome was absolute change in tibiofemoral cartilage volume assessed using MRI over 24 months (the minimum clinically important difference [MCID] has not been established). Three prespecified secondary outcomes were change in knee pain assessed by a visual analog scale (0 [no pain] to 100 [unbearable pain]; MCID, 15) and the Western Ontario and McMaster Universities Osteoarthritis Index (0 [no pain] to 500 [unbearable pain]; MCID, 75) over 3, 6, 12, 18, and 24 months and change in bone marrow lesion size over 6 and 24 months (the MCID has not been established). Of 223 participants enrolled (mean age, 62.0 years [SD, 8.0 years]; 52% were female), 190 (85%) completed the trial. Change in tibiofemoral cartilage volume was not significantly different between the zoledronic acid group and the placebo group over 24 months (-878 mm3 vs -919 mm3; between-group difference, 41 mm3 [95% CI, -79 to 161 mm3]; P = .50). No significant between-group differences were found for any of the prespecified secondary outcomes, including changes in knee pain assessed by a visual analog scale (-11.5 in the zoledronic acid group vs -16.8 in the placebo group; between-group difference, 5.2 [95% CI, -2.3 to 12.8]; P = .17), changes in knee pain assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (-37.5 vs -58.0, respectively; between-group difference, 20.5 [95% CI, -11.2 to 52.2]; P = .21), and changes in bone marrow lesion size (-33 mm2 vs -6 mm2; between-group difference, -27 mm2 [95% CI, -127 to 73 mm2]; P = .60) over 24 months. Adverse events were more common with zoledronic acid than with placebo (96% vs 83%, respectively) and consisted mainly of acute reactions (defined as symptoms within 3 days of administration of infusion; 87% vs 56%). Among patients with symptomatic knee osteoarthritis and bone marrow lesions, yearly zoledronic acid infusions, compared with placebo, did not significantly reduce cartilage volume loss over 24 months. These findings do not support the use of zoledronic acid in the treatment of knee osteoarthritis. anzctr.org.au Identifier: ACTRN12613000039785.

Footwear for osteoarthritis of the lateral knee: protocol for the FOLK randomised controlled trial

BackgroundStructural features of lateral tibiofemoral (TF) joint osteoarthritis (OA) occur in up to half of all people with knee OA, and co-existing lateral TF OA is associated with worse knee pain in people with mixed compartmental knee OA. Clinical guidelines for management of knee OA advocate advice about appropriate footwear, yet there is no research evaluating which types of footwear are best for managing pain associated with lateral TF OA. Biomechanical evidence suggests that “motion-control” footwear, which possess midsoles that are stiffer medially compared to laterally, may shift load away from the lateral compartment of the knee and thus may reduce knee pain associated with lateral TF OA. The primary aim of this study is to compare the effects of motion-control shoes to neutral shoes on knee pain in people with predominantly lateral TF OA.MethodsThis will be an assessor- and participant-blinded, two-arm, comparative effectiveness randomized controlled trial (RCT) conducted in Melbourne, Australia. We will recruit a minimum of 92 people with painful lateral TF OA from the community. Participants will be randomly allocated to receive either motion-control shoes or neutral shoes and will be instructed to wear their allocated shoes for a minimum of 6 h per day for 6 months. The primary outcome is change in self-reported knee pain on walking, measured using a numerical rating scale, assessed at baseline and 6 months. Secondary outcomes include other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity levels.DiscussionThis study will compare the efficacy of motion-control shoes to neutral shoes for people with painful lateral TF OA. Findings will be the first to provide evidence of the effects of footwear on knee pain in this important subgroup of people with knee OA and allow clinicians to provide accurate advice about the most appropriate footwear for managing pain associated with lateral TF OA.Trial registrationThis trial has been prospectively registered by the Australian New Zealand Clinical Trials Registry on 15/11/2018 (reference: ACTRN12618001864213).

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

BackgroundStudies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA.MethodsThe PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation.ResultsSeven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: − 0.31; 95% confidence interval (CI): − 0.55 to − 0.06; P = 0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: − 0.54 to − 0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P > 0.05).ConclusionsCompared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone.

Effectiveness of intramuscular gluteal glucocorticoid injection versus intra-articular glucocorticoid injection in knee osteoarthritis: design of a multicenter randomized, 24 weeks comparative parallel-group trial

BackgroundThe knee is symptomatically the most frequent affected joint in osteoarthritis and, in the Netherlands and other Western countries, is mainly managed by general practitioners (GPs). An intra-articular glucocorticoid injection is recommended in (inter) national guidelines for patients with knee osteoarthritis as an option for a flare of knee pain and/or for those who are not responding well to pain medication. An innovative approach that could replace the intra-articular injection is an intramuscular gluteal glucocorticoid injection. An intramuscular injection is easier to perform than an intra-articular injection with lesser risk of severe local adverse reactions. We hypothesize that intramuscular gluteal glucocorticoid injection is non-inferior in reducing knee pain compared to intra-articular glucocorticoid injection, with potentially a longer lasting effect than intra-articular injection.Methods/designThe study will be a pragmatic randomized controlled non-inferiority trial with two parallel groups. A total of 140 patients aged 45 years and older with knee osteoarthritis who contacted their general practitioner and have persistent knee pain (score ≥ 3 on 0–10 numerical rating scale; 0 = no knee pain) will be included.Patients will be randomly allocated (1:1) to an injection of 40 mg triamcinolone acetonide intra-articular in the knee joint or intramuscular in the ipsilateral ventrogluteal area.The effect of treatment will be evaluated by questionnaires at 2, 4, 8, 12, and 24 weeks after injection. The primary outcome is patients’ reported severity of knee pain measured with the pain subscale of the Knee injury and Osteoarthritis Outcome Score 4 weeks after injection. Statistical analysis will be based on both the per-protocol and the intention-to-treat principle.DiscussionThis study will evaluate non-inferiority of intramuscular glucocorticoid injection compared to intra-articular glucocorticoid injection for knee osteoarthritis symptoms.Trial registrationThis trial is registered in the Dutch Trial Registry (number NTR6968) at 2018-01-22 (https://www.trialregister.nl/trial/6784). Issue date: 1 October 2019.Trial sponsorErasmus MC University Medical Center Rotterdam.PO-box 2040.3000 CA Rotterdam.The Netherlands.

Clinical Faceoff: Suprapatellar Tibial Nailing for Tibia Fractures.

Clinical Faceoff: Suprapatellar Tibial Nailing for Tibia Fractures.

Hip abductor strength and its association with new or worsening knee pain: the most study

Purpose: Adults with knee osteoarthritis (OA) frequently have significant hip abductor and quadriceps weakness. Given the importance of the hip abductors in controlling pelvic orientation and rotation of the femur during gait, both of which affect knee biomechanics, hip abductor weakness may influence the development or worsening of knee pain. One trial of hip strengthening exercises suggests a reduction in knee pain with increased strength; however, hip exercises may also affect knee strength making it unclear if improvements were due to hip or knee strength.

A multicentre randomised double-blind placebo-controlled trial of zoledronic acid for knee osteoarthritis - the zap2 trial

Purpose: A proof of principle study suggests that zoledronic acid may reduce knee pain and size of bone marrow lesions (BMLs) in people with knee osteoarthritis, but data from large trials is lacking. The aim of this study was to compare the efficacy of zoledronic acid vs placebo on knee cartilage volume, knee pain and BML size in patients with symptomatic knee osteoarthritis and BMLs.

During two years, what is the difference between an exclusive two-day educational program on OA and a program that adds multimodal attention for 6 moths in the treatment of OA?

Purpose: Osteoarthritis (OA) is the leading skeletal cause of years lived in disability. Education/self-management, diet if overweight and exercise are considered core treatment in several guidelines including OARSI’s 2014 and 2019. The aim of this study was to evaluate the effectiveness in reducing body fat and secondarily reducing knee pain, improving function and increasing exercise hours of a six months (20 interventions) educational/multiprofessional care program to a two-day educational program. Methods: Prospective randomized clinical trial with 116 patients with grades II and III K&L knee OA (KOA) and multiple OA were randomized to one of two groups: control (usual care with medical appointments at inclusion, six, 12 and 24 months) and two periods of 5 hours of lectures, two month apart, about OA with a multiprofessional group) and a group with an extended intervention program (same as the control group and seven sessions of collective physical therapy, seven sessions of group physical fitness, two group sessions of discussion about diet with the nutritionist and two about engaging the program with the psychotherapist) along the first six months of the program. Six months after inclusion, patients of the extended interventation group (EIG) were oriented to continue diet and to exercise at local gyms or at home. All patients were evaluated at inclusion, six, 12 and 24 months. VAS, WOMAC, Lequesne, and measures of BMI, percentage of lean and body fat, Body weight, fat weight, lean weight, Hip-waist ratio (HWR), timed up and go (TUG), 30 second chair stand test (30CST), Timed up and down stairs (TUDS), 6-minute walk test (6MWT) and adherence to physical activity (IPAQ) were taken at baseline, six, twelve and 24 months. Results: Tables 1, 2 and 3 summarize the results. Groups were similar at baseline (p>0.05) except for WOMAC stiffness, that in all moments was, in average, 0.68 less in the study group (p=0.019) despite both groups improving progressively throughout the study period (p<0.05). Control group had a higher number of dropouts at one year (15 in total (25%), 13 in the first six months, without dropouts in the second year), whereas seven (12%) abandoned the EIG (six in the first six months and one before one year). At six months evaluation, all parameters were better in the study group (p<0.05) with the exception of HWR, TUG and lean weight. HWR and TUG did not vary during the study. Only the EIG improved pain (VAS) from baseline to all moments (p<0,002), but both groups improved pain by WOMAC pain with similar results at 2 years. Lequesne, TUDS, 6MWT, IPAQ results improved in all moments for both groups without a significant difference between groups. WOMAC function and total and the 30CST improved faster in the EIG with more than 15 points difference in WOMAC at 6 months (At two years, groups presented similar results with loss of the EIG results and continued gain of the CG). Only the EIG reduced body weight (p<0.001), BMI (p=0.002), fat weight (p<0.05) in all moments. Both groups reduced and had similar percentage of body fat at two years follow-up (with gain in body fat percentage of the EIG in the second year and continued loss of the CG during the study period). Conclusions: In patients with multiple OA (and knee OA), both methods improve pain and function. The extended intervention program improves more rapidly pain, adherence to the program and physical activity level, and function when compared to a two-day class only group. Loss of body weight, fat weight and BMI was only achieved by the extended program with partial loss of results probably due to ceasing group interventions after 6 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effects of Class IV Laser in Knee Osteoarthritis: A Randomized ControlTrial

Background: Knee osteoarthritis (KOA) is characterized by a gradual wearing away of the cartilage in the joint through strain originating from weight bearing, repeated injury, and/or damage and is one of the most associated causes of knee pain. Current options for pain management include medication or surgery. Consequently patients are alternatively seeking a non-invasive approach that can help manage their pain. Recently, Class IV laser has gained popularity due to its clinical efficacy in pain management and non-invasive application. Objective: The aim of this randomized control trial was to evaluate the effects of a 30W powered Class IV laser with 1064 nm wavelength on knee pain in the treatment of patients with KOA. Methods: Patients were randomly assigned into two groups. Each patient underwent 7 treatment sessions every other day. Group-I (Laser group): 30 patients were treated with a semi conductive Class IV Laser with Scanning System applicator (BTL Industries Ltd.) With a maximal power of 30 W and 1064 nm wavelength. Group-II (Control group): 30 patients were treated with the same device without emission from the laser diode, and only a visible navigation beam to act as a placebo. All patients perception of pain was evaluated prior to beginning treatment (baseline), following the first session, after the 7 therapies, and 1 month following the last treatment using the Visual Analogue Scale (VAS). Results: The Man-Whitney test revealed there was a significant (P=0.01) reduction in pain according to the VAS results for the laser group (44.24% improvement), whereas the control group displayed no significant difference (3.93% improvement) in pain perception following the treatment(s). Conclusion: Class IV laser treatment was found to be an effective modality in reducing knee pain in KOA patients.

PELATIHAN LANSIA BEBAS NYERI LUTUT DI PATUKAN AMBARKETAWANG KECAMATAN GAMPING KABUPATEN SLEMAN

The increasing of Indonesian life expectancy needs to be balanced with the ability of independence in the health aspect of the elderly community. Patukan Ambarketawang Yogyakarta has high in a number of elderly people. Knee pain experienced by the elderly, which have an impact on reducing their activity and productivity. Isoquadrisep exercises are one of the non-pharmacological efforts that are recommended to prevent knee pain. Elderly Posyandu in Patukan Ambarketawang Gamping Sleman village conducts routine activities to control the health of the elderly in general such as to measure blood pressure. Posyandu cadres and elderly participants are not familiar with isoquadrisep exercises on the knee to reduce knee pain in the elderly. Community partnership service is carried out to form cadres and isoquadrisep exercise training to prevent elderly with knee pain. The method for this activity is Training Of Trainer on quadriceps exercise for cadres and some communities. The results of this activity are cadres have an isoquadricep exercise agenda at each elderly meeting alternating with other exercises that already existed in Patukan Ambarketawang Gamping.

Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome

BackgroundArthroscopic closure release includes arthroscopic lateral patella retinaculum releasing (LPRR) either outside synovial membrane (OSM) or through synovial membrane (TSM). At present, there is no research to compare the clinical efficacy of the above two methods for the treatment of lateral patellar compression syndrome (LPCS). So, the goal of this study was to investigate the method and overcome of arthroscopic LPRR either OSM or TSM for the treatment of LPCS.MethodsFrom September 2014 to December 2017, 125 patients of LPCS underwent arthroscopic LPRR either OSM or TSM combined with joint debridement. In the OSM group, knee joint was cleaned first. The surface of lateral patella retinaculum (LPR) was created the chamber for arthroscopic operation to release LPR. Synovial membrane was retained. In the TSM group, knee joint was cleaned first. Then synovial membrane, joint capsule and LPR, and superficial fascia were gradually incised from the joint cavity to subcutaneous tissue. The synovial membrane was cut open. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were collected for evaluating clinical overcomes.ResultsAll patients were followed up for 1.5–5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The Lysholm score, the distance of patella medial shift, Kujala score, and VAS score in the OSM group and the TSM group were significantly improved in the final follow-up compared with before surgery (All P < 0.001), but these observed targets before surgery and at the last follow-up were compared between the OSM group and the TSM group with no statistical differences. However, the number of occurrences of joint hematoma and adhesion was significantly higher in the TSM group than the OSM group (P = 0.024).ConclusionsArthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of patellofemoral joint with the advantages of small trauma, rapid recovery and less complications. But, the number of occurrences of hemarthrosis and joint adhesion were significantly higher in the TSM group than in the OSM group.Trial registrationThe trial registration number (IRCT): IRCT20200205046378N1 and date of registration: February 10, 2020 (retrospectively registered).

Effectiveness of collagen supplementation on pain scores in healthy individuals with self-reported knee pain: a randomized controlled trial

The purpose of this study was to examine the effects of 12 weeks collagen peptide (CP) supplementation on knee pain and function in individuals with self-reported knee pain. Healthy physically active individuals (n = 167; aged 63 [interquartile range = 56-68] years) with self-reported knee pain received 10 g/day of CP or placebo for 12 weeks. Knee pain and function were measured with the Visual Analog Scale (VAS), the Lysholm questionnaire, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Furthermore, we assessed changes in inflammatory, cartilage, and bone (bio)markers. Measurements were conducted at baseline and after 12 weeks of supplementation. Baseline VAS did not differ between CP and placebo (4.7 [2.5-6.1] vs. 4.7 [2.8-6.2], p = 0.50), whereas a similar decrease in VAS was observed after supplementation (-1.6 ± 2.4 vs. -1.9 ± 2.6, p = 0.42). The KOOS and Lysholm scores increased after supplementation in both groups (p values < 0.001), whereas the increase in the KOOS and Lysholm scores did not differ between groups (p = 0.28 and p = 0.76, respectively). Furthermore, CP did not impact inflammatory, cartilage, and bone (bio)markers (p values > 0.05). A reduced knee pain and improved knee function were observed following supplementation, but changes were similar between groups. This suggests that CP supplementation over a 12-week period does not reduce knee pain in healthy, active, middle-aged to elderly individuals. Novelty CP supplementation over a 12-week period does not reduce knee pain in healthy, active, middle-aged to elderly individuals. CP supplementation over a 12-week period does not impact on inflammatory, cartilage, and bone (bio)markers in healthy, active, middle-aged to elderly individuals.

KARAOKE: Krill oil versus placebo in the treatment of knee osteoarthritis: protocol for a randomised controlled trial

BackgroundKnee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at modifying structures visible on imaging have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA.Methods/designWe will recruit 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI in five Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). These patients will be randomly allocated to the two arms of the study, receiving 2 g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses.DiscussionThis study will provide high-quality evidence to assess whether krill oil 2 g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616000726459. Registered on 02 June 2016.Universal Trial Number (UTN) U1111–1181-7087.

Patellar Bone-Grafting for Severe Patellar Bone Loss During Revision Total Knee Arthroplasty

Treatment of severe patellar bone loss during revision total knee arthroplasty (TKA) is difficult. Patellar bone-grafting is a simple procedure that can improve patient outcomes following revision TKA. The patient is prepared and draped in the usual sterile fashion. The previous longitudinal knee incision is utilized for exposure. Scar tissue is excised from the medial gutter. However, tissue in the lateral gutter is largely maintained. An assessment of the surrounding quadriceps and patellar scar tissue ensues. This tissue can be utilized to create an envelope for holding the bone graft in place. If insufficient tissue is present, fascia from the iliotibial band or vastus medialis, allograft fascia, or synthetics can be used.A careful assessment of component fixation and rotation is critical to the success of patellar bone-grafting. Component revision for aseptic loosening or malrotation should be performed in the usual fashion. During component revision, it is recommended to preserve any additional bone as autograft for the patellar bone-grafting procedure. Common sites of autograft harvest include the femoral box cut and proximal tibial resection.The patella is then addressed by carefully removing the previous implant to avoid additional bone loss. This step is performed with a combination of an oscillating saw, osteotomes, and high-speed burr. The retropatellar bone is then prepared by debriding excess soft tissue, cysts, or cement. A high-speed burr is then utilized to produce a punctate bleeding surface for bone-graft incorporation.The harvested tissue is closed around the perimeter of the patella with use of interrupted nonabsorbable sutures, leaving a window to pack in the bone graft. The bone graft (allograft and autograft) is morselized and place through the window.The optimal patellar thickness is variable. After packing the bone graft through the soft-tissue window, the thickness is measured with a caliper. It is recommended to acquire a thickness of >20 mm because bone-graft resorption and remodeling occur with knee range of motion. The remaining soft-tissue window is closed with use of nonabsorbable sutures. The knee is cycled through a range of motion to ensure optimal patellofemoral tracking. If necessary, a lateral release or medial soft-tissue advancement can be performed to ensure patellofemoral tracking is adequate. Finally, the wound is irrigated and closed in layers. Nonsurgical:Patellar knee braceHinged knee braceSurgical:Gull-wing osteotomyPatellar resurfacing with biconvex patellaBulk allograft reconstructionPartial or complete patellectomyPatelloplastyInterpositional arthroplastyTantalum metal-backed reconstruction. There is a myriad of surgical options for severe patellar bone loss following TKA. Patellar bone-grafting is simple, reproducible, and relatively cost-effective1,2, and avoids the need for the amount of bone for reconstruction that may be required for metal-backed or biconvex patellar implants3,4. The procedure allows for the restoration of the quadriceps lever arm, which may not be restored with other techniques, such as gull-wing osteotomy or patellectomy5. Patellar bone-grafting avoids the cost and risks of disease transmission associated with allograft reconstruction6. Finally, the procedure provides excellent long-term survivorship and patient-reported outcomes. Following this procedure, patients should experience a reduction in knee pain and improved patient-reported outcomes2,6, with a prior study showing that the percentage of patients reporting anterior knee pain decreased from 51% to 27% following patellar bone-grafting. Patients also demonstrated an improvement in knee range of motion, with a mean increase in knee flexion of 7o and knee extension of 2o1. Complications related to this procedure are minimal. Bone stock restoration can be utilized for patellar resurfacing in the future1. Radiographically, patellar bone resorption, loss of patellar height, and patellar remodeling do occur; however, despite these radiographic changes, Knee Society scores increased from 50 to 85 at the time of the latest follow-up. Careful preoperative physical examination should document range of motion, areas of pain, and patellofemoral tracking and/or instabilityBe prepared to revise the femoral and/or tibial components if malrotated in order to optimize patellofemoral trackingRetain any autogenous bone harvested during component revision to use as patellar bone graftEnsure that allograft bone is available to ensure sufficient restoration of patellar thicknessConsider having allograft tissue available in the event that scar tissue in situ is not adequate to create an envelope for packing the bone graftA bleeding retropatellar surface prepared with a high-speed burr will increase the chance of bone incorporationA watertight closure of the soft-tissue envelope is critical to avoid loss of bone graft during knee range of motion.

Comparison of Subjectively Perceived Pro-Health Effects of Practicing Various Forms of Body &amp; Mind Training in Women

Background: Body & mind trainings are forms of aerobics, the aim of which, apart from improving physical fitness, is to additionally provide mental relaxation. The aim of this study was a comparison of physical and mental pro-health effects from practicing Hatha yoga, Pilates and bodyART. Material and methods: Our own self-assessment questionnaire was used assess the impact of selected forms of body & mind training on the physical and mental fitness of people regularly practicing the forms. A group of 81 women practicing Hatha yoga, Pilates or bodyART for a minimum of 2 workouts per week were qualified. Additional inclusion criteria involved at least a 2-month training period and not practicing the other sport disciplines in study period. Results: After regular body & mind training, significant beneficial changes involving primarily the reduction of joint pain and increased flexibility were subjectively noticed by the participants. Changes included a significant reduction of back pain for Hatha yoga and Pilates and reduction of knee pain and improvement of the sense of balance for bodyART. Conclusions: Practicing body & mind forms has a beneficial impact on the perception of psychophysical health, regardless of the type of training, while the bodyART form generally showed the greatest number of effects.

Bilateral versus unilateral total knee replacement with 35-day morbidity and mortality: A Bi-Centre prospective cohort study

BackgroundTotal Knee Replacement (TKR) has been the most successful intervention that reduces knee pain and improves physical function of rheumatoid arthritis patients. This study aims to compare the complications and recovery for bilateral versus unilateral TKR within 35 days of post-surgery. MethodThis is a prospective observational study that was done in two medical centres in Saudi Arabia. All patients who underwent primary TKR surgery in the included medical centres between the period of October 2018 till July 2019 were eligible for this study. A prospective data collection sheet was used to follow up for each patient for 35 days of post-surgery. Results242 patients were involved in this study. The mean age for unilateral TKR patients was 66.95 ± 8.91 years, whereas 64.53 ± 8.88 years for bilateral TKR patients. Days required to start walking post-operation of unilateral TKR were significantly higher than that of bilateral TKR (2.66 ± 1.13 days versus 2.30 ± 0.98 days). Deep vein thrombosis (DVT) was found in bilateral TKR 11 (4.5%) more than 4 (1.7%) unilateral TKR. Confirmed diagnosis (pulmonary embolism (PE) or DVT) was observed in 10 (4.2%) bilateral TKR more than unilateral TKR 2 (0.8%). ConclusionThere are significant differences between bilateral and unilateral TKR in terms of recovery and DVT complications.