Knee Pain Relief Research Articles

Effect of Persian acupressure (Ghamz) on Patients with Knee Osteoarthritis: A Single-Blinded Parallel Clinical Trial

BackgroundMany patients choose complementary and alternative medicine (CAM) to treat various conditions. Among osteoarthritis patients, acupressure is a popular CAM treatment. In Iran, Ghamz (a Persian acupressure technique) uses for musculoskeletal ailments like knee pain. AimsTo examine the potential efficacy of Ghamz on osteoarthritis outcomes. DesignClinical Trial. SettingsRandomized, single-blind, sham-controlled clinical trial. Participants/SubjectsEighty patients with diagnosed knee osteoarthritis, age over 35 years old. MethodsEighty adult patients with confirmed knee osteoarthritis from three outpatient clinics were recruited. Participants were randomly assigned either to intervention or placebo groups using sham acupressure. The primary outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) parameters and pain scores measured using the visual analog scales (VAS). ResultsSeventy-two individuals completed the trial and were included in the analysis. At baseline, there was no difference between the mean scores of both outcomes. After the intervention, the group receiving Ghamz therapy experienced an improvement in KOOS parameters, including symptoms, pain, activity daily livings, sport, recreation function, and quality of life. The mean pain score in the intervention group was significantly decreased from 5.89 at the beginning study to 4.11 at the end of the study, while the pain score did not change substantially in the sham group. These findings remained consistent after adjusting for covariates of age, weight, and pre-treatment. ConclusionsThis study supports evidence that Ghamz therapy provides an effective option for short-term knee pain relief in patients with knee osteoarthritis. Additional studies are recommended to confirm these findings.

Mucoid degeneration of the posterior cruciate ligament in a college soccer player: a case report

BackgroundTo the best of our knowledge, arthroscopic treatment for symptomatic mucoid degeneration of the posterior cruciate ligament in young athletes has not been reported before.Case presentationAn 18-year-old Asian male college soccer player presented with a 3-month history of right knee pain without episodes of trauma. Despite conservative treatment over the preceding 3 months, his symptoms persisted. Physical examination of the right knee revealed full range of motion, though posterior knee pain was induced when the knee approached full flexion. On ligament examination, posterior sagging and Lachman test were negative, and no clinical finding indicative of ligament insufficiency was noted. Magnetic resonance imaging showed a diffusely thickened posterior cruciate ligament with increased signal intensity on the T2-weighted sequence. A few intact fibers were observed with continuous margin from origin to insertion. Based on the patient's history and the magnetic resonance imaging findings, we suspected mucoid degeneration of the posterior cruciate ligament as the cause of the patient’s symptoms. Since conservative treatment had failed to relieve the symptoms, arthroscopic treatment was indicated. Arthroscopic examination revealed yellowish crumbly tissues along the thickened posterior cruciate ligament. Tension and bulk of the posterior cruciate ligament were well preserved. Curettage of degenerative tissue and decompression of the posterior cruciate ligament resulted in symptom relief without instability of the knee joint. The patient returned to play at 3 months. At 12 months, postoperative magnetic resonance imaging showed no evidence of recurrence and indicated that the remaining posterior cruciate ligament was thicker than before the surgery. At 2 years follow-up, the patient remained asymptomatic and could play soccer at the same level as before the onset of pain.ConclusionsArthroscopic decompression of the posterior cruciate ligament may relieve knee pain and facilitate early return to play with good functional results.

COMPARATIVE STUDY BETWEEN INTRA-ARTICULAR CORTICOSTEROID INJECTION AND GENICULAR NERVE BLOCK UNDER ULTRASOUND GUIDANCE IN PAIN CONTROL OF KNEE OSTEOARTHRITIS

Recently, genicular nerve block (GNB) was introduced as a new technique to relieve knee pain in chronic knee osteoarthritis patients. While intra-articular corticosteroid injection (IACSI) used to be a traditional treatment option to relieve knee osteoarthritis related pains. Both techniques have been used. However, whether one is superior to the other remains controversial.Aim of work: This study aims to investigatethe efficacy of ultrasound-guided GNB and IACSI in the management of knee osteoarthritis-related pains and to determine which technique carried better results.Methods:Forty patients with chronic knee osteo-arthritis were randomly treated with either genicular nerve block (GNB) (n = 20) or intra-articular corticosteroid injection (IACSI) (n = 20). Clinical response was assessed using Visual analog scale (VAS), and Oxford Knee Score (OKS) at baseline and 2, 4, and 8 weeks post procedure. Results: The VAS score and OKS score were significantly low in the GNB group and IACSI group at 2, and 4 weeks after the procedure (P < 0.001 for all), then returned near baseline at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (P < 0.001 for 2 and 4 weeks and < 0.006 for 8 weeks) and improvement in function (P < 0.001 for 2, 4 and 8 weeks) compared to IACSI group.

Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial.

Severe acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.

Efficacy of rtsa-byugs vs diclofenac gel in relieving knee pain of patients with osteoarthritis of the knee

PurposeRtsa-byugs, a massage oil from Bhutan, is a traditional herbal formula known for its anti-inflammatory properties and used in osteoarthritis treatment. This study investigates the efficacy of rtsa-byugs vs diclofenacgel in relieving knee pain in osteoarthritis patients.Design/methodology/approachA single-blind, randomized controlled trial was conducted amongst osteoarthritis knee patients at an orthopedic outpatient department of Thammasat University Hospital. Participants were randomly allocated to the rtsa-byugs (N = 31) or the Diclofenac gel (N = 31) group. Primary outcomes were assessed by the knee injury and osteoarthritis outcome scores (KOOS), visual analog scale (VAS) and goniometer at day 0, 1, 3, 7.Findings62 participants completed the study. The result of the KOOS scores demonstrated a significant improvement of symptoms at the end of the study in both treatment groups. Improvement of symptoms, pain, daily life living, sport and recreational score and quality of life assessment showed a significant difference from baseline (p &lt; 0.001) within both groups. The quality of life score for the rtsa-byugs group increased significantly on day 3 and 7. The VAS score in both groups decreased with a significant difference from baseline to day 7. The mean value of extension of angle measurement was decreased in day 7, and the mean of flexion score increased in both groups when compared with the baseline.Research limitations/implicationsThe duration of the study was very limited and included a small sample consisting of men and women.Originality/valueRtsa-byugs is safe and effective in relieving pain from osteoarthritis of the knee and can be used as an alternative treatment for knee osteoarthritis.

Cooled radiofrequency ablation provides extended clinical utility in the management of knee osteoarthritis: 12-month results from a prospective, multi-center, randomized, cross-over trial comparing cooled radiofrequency ablation to a single hyaluronic acid injection

BackgroundSafe and effective non-surgical treatments are an important part of the knee osteoarthritis (OA) treatment algorithm. Cooled radiofrequency ablation (CRFA) and hyaluronic acid (HA) injections are two commonly used modalities to manage symptoms associated with knee OA.MethodsA prospective 1:1 randomized study was conducted in 177 patients comparing CRFA to HA injection with follow-ups at 1, 3, 6 and 12 months. HA subjects with unsatisfactory outcomes at 6-months were allowed to crossover and receive CRFA. Knee pain (numeric rating scale = NRS), WOMAC Index (pain, stiffness and physical function), overall quality of life (global perceived effect = GPE, EQ-5D-5 L), and adverse events were measured.ResultsAt 12-months, 65.2% of subjects in the CRFA cohort reported ≥50% pain relief from baseline. Mean NRS pain score was 2.8 ± 2.4 at 12 months (baseline 6.9 ± 0.8). Subjects in the CRFA cohort saw a 46.2% improvement in total WOMAC score at the 12-month timepoint. 64.5% of subjects in the crossover cohort reported ≥50% pain relief from baseline, with a mean NRS pain score of 3.0 ± 2.4 at 12 months (baseline 7.0 ± 1.0). After receiving CRFA, subjects in the crossover cohort had a 27.5% improvement in total WOMAC score. All subjects receiving CRFA reported significant improvement in quality of life. There were no serious adverse events related to either procedure and overall adverse event profiles were similar.ConclusionA majority of subjects treated with CRFA demonstrated sustained knee pain relief for at least 12-months. Additionally, CRFA provided significant pain relief for HA subjects who crossed over 6 months after treatment.Trial registrationThis trial was registered on ClinicalTrials.gov, NCT03381248. Registered 27 December 2017

A clinico-radiological evaluation of functional outcome of proximal fibular osteotomy for medial compartment knee osteoarthritis: a new emerging technique

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The medial compartmental osteoarthritis (OA) knee is initially treated conservatively followed by lateral close/open medial wedge high tibial osteotomy (HTO), or by unicompartmental or total knee replacement (UKR/TKR). Though HTO and UKR/TKR yield good results but are technically more demanding and are fraught with risk of complications, moreover replacement may not be the treatment of choice for younger patients. The objective of this study was to evaluate the efficacy of proximal fibular osteotomy (PFO), a minimally invasive procedure minus risks associated with HTO/TKR.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Thirty-eight patients, 15 males and 23 females with a mean age of 54.46 years (range, 35 to 80 years) underwent PFO for OA knee and were followed for a mean period of 8.63 months (range 6 to 12 months).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; After PFO all patients experienced immediate significant relief in medial knee pain with improved walking distance. Postoperatively, all patients showed radiological improvement in femorotibial angle (FTA), medial/lateral joint space ratio.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PFO is safe, minimally invasive technique with minimal complications. It gives immediate relief of medial knee pain with improved function of joint.&lt;/p&gt;

A Nobel procedure for symptomatic pain relief in medial compartment knee osteoarthritis in countries of low socioeconomic status

Background: The author found simpler, safe, effective, affordable, easy to perform, surgical procedure called partial fibular osteotomy (PFO) as compared to high tibial osteotomy and total knee replacement which could effectively relieve knee pain and also correct the varus deformity for patient with medial compartment knee osteoarthritis kellgren and Lawrence grade I to III. Methods: 40 patients with medial compartment knee osteoarthritis who presented between January 2018 to July 2019 were treated by proximal fibular osteotomy in author’s hospital all were followed for 1.5 yrs. Anteroposterior and lateral weight bearing radiographs, the femorotibial angle (FTA) and lateral joint space and America knee society score (KSS) and visual analog scale (VAS) of knee joint were evaluated preoperatively and at 3month, 6 month and at final follow up respectively. Results: At final follow mean FTA and lateral knee joint space were (172+_1.8) and (2.18+_0.8), which were significantly smaller than those measured preoperatively (184.27+_2.4) and (5.22+_1.2) respectively; both p

High tibial osteotomy combined with arthroscopy for elderly patients with knee osteoarthritis of medial compartment

To observe early clinical effect of high tibial osteotomy combined with arthroscopy for elderly patients with knee osteoarthritis of medial compartment. Sixty-one elderly patients with medial compartment knee osteoarthritis were treated with high tibial osteotomy combined with arthroscopy from August 2017 to October 2018. Among them, including 17 males and 44 females, aged from 60 to 83 years old with an average of (67.87±6.45) years old. Weight bearing line (WBL) and femora-tibial angle (FTA) were analyzed to assess lower limb alignment before and 12 months after surgery. Visual analogue scale (VAS) score and Hospital for Special Surgery (HSS) score were used to evaluate knee pain and function before and 1, 3, 12 months after surgery. All patients were followed up from 12 to 19 months with an average of (14.27±4.69) months. WBL was improved from (14.79±5.61) % before operation to (59.33±7.82) % at 12 months after operation (t=2.294, P<0.05), FTA was improved from (182.14±2.19) ° before operation to (171.54±3.16) ° at 12 months after operation (t=1.827, P<0.05) . VAS score decreased from 6.14±2.21 before operation to 3.64±0.92, 2.02±0.63 and 0.93±0.61 at 1, 3 and 12 months after operation (F=458.24, P<0.001), HSS score increased from 49.66±13.79 to 58.39±9.26, 71.82±6.06 and 82.71±6.97 at 1, 3 and 12 months after operation (F=266.45, P<0.001) . Three patients had contralateral cortical fracture during surgery, whose osteotomy area healed well at 12 months after surgery. The incision healing of 4 cases was slow, while all healed at 3 to 4 weeks after surgery. High tibial osteotomy combined with arthroscopy could adjust lower limb alignment effectively, relieve knee pain and functional dysfunction, which indicated a significant short term efficacy on the elderly patients with knee osteoarthritis of medial compartment.

Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case‐Control Study

ObjectiveTo investigate whether intravenous combined with topical administration of tranexamic acid (TXA) is superior to intravenous administration alone in terms of blood loss, incision complications, functional recovery, and pain relief in high tibial osteotomy (HTO).MethodsClinical data of patients with knee osteoarthritis (OA) treated with unilateral HTO were retrospectively reviewed. The patients were grouped according to the TXA administration method, with 24 patients in the combined group and 21 in the solo group. In the combined group, 100 mL saline containing 1 g TXA was intravenously administered before application of a tourniquet, and 20 mL saline containing 2 g TXA was injected through a drainage tube after closure of the incision. Alternatively, 100 mL of saline containing 1 g TXA was intravenously administered before application of a tourniquet in the solo group. The blood loss and adverse events were compared between the two groups.ResultsAll patients were followed for more than half a year. The drainage volume on the first day and total blood loss on the second day after surgery in the combined and single treatment groups were 130.06 ± 29.22 and 165.35 ± 43.08 mL (P < 0.05), respectively, and 327.17 ± 64.26 and 385.45 ± 63.31 mL (P < 0.05). There were no blood transfusions in either group. One case of delayed incision healing was observed in the solo group, and no such event occurred in the combined group. There were no significant differences between the two groups in terms of the following factors: the activated partial thromboplastin time (APTT) and prothrombin time (PT); levels of fibrinogen (FIB) and D‐dimer on the second day after surgery; numbers of hospitalization days and thromboembolism events; and knee joint function and visual analog score 6 months after surgery.ConclusionIntravenous combined with topical TXA administration in HTO is superior to intravenous administration alone for reducing postoperative blood loss and drainage volume without thromboembolic complications. However, even with only intravenous TXA administration, no cases of blood transfusion and only 1 case of incision complication occurred. At the same time, the combined use of TXA did not improve the recovery of knee joint function and pain relief after HTO.

Distal tibial tuberosity high tibial osteotomy using an image enhancement technique for orthopedic scans in the treatment of medial compartment knee osteoarthritis

ObjectiveTo observe the efficacy of distal tibial tuberosity high tibial osteotomy in treating medial compartment osteoarthritis of the knee. In the experiment, a medical image enhancement algorithm based on shear wave domain improved Gamma correction was implemented to process medical images in order to diagnose patients more effectively. MethodsSixty-five patients (13 males and 52 females) were included in the study who were treated with distal tibial tuberosity high tibial osteotomy, and the mean age of the patients was 63±6 years (range 49–73). All patients received X-Ray and MRI before surgery. We carefully studied and analyzed the findings, MRI findings and medical characteristics after using the shearlet domain to improve the Gamma correction method in order to enhance diagnostic accuracy. The improved image help us to judge the damage of the medial and lateral compartment more accurately. Weight bearing line (WBL) and femora-tibial Angle (FTA) were measured to evaluate the lower limb alignment before and 12 months after surgery. Visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, the Westrn Ontario and Mcmaster Universities (WOMAC) scores were recorded to evaluate knee pain and function before surgery, 3 months and 6 months after surgery. ResultsThe X-Ray and MRI scans of the patients were analyzed. After the shear wave shearlet domain is implemented, the image effect is significantly improved. 12 months after surgery, WBL was improved from 16.34±2.18% to 60.32±2.89% (p<0.05), FTA was improved from 171.17±1.87° to 179.83±2.14° (p<0.05). At 3 months and 12 months after surgery, VAS, HSS and WOMAC scores were significantly improved compared with baseline (p<0.05). ConclusionDistal tibial tuberosity high tibial osteotomy is able to correct varus deformity, relieve knee pain and the functional dysfunction, indicating which had a significant short-term efficacy. The shear wave shearlet domain incorporates the Gamma correction method to effectively preserve the image details, which to achieve a more accurate diagnosis, and help us to judge the damage of the medial and lateral compartment more accurately.

Clinical Efficacy and Safety of Yellow Oil Formulations 3 and 4 versus Indomethacin Solution in Patients with Symptomatic Osteoarthritis of the Knee: A Randomized Controlled Trial.

Background Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for the treatment of symptomatic osteoarthritis (OA) of the knee. However, searching for alternatives such as locally available medicinal herbs to manage OA knee pain remains of clinical value. The objective of the present study was to evaluate the efficacy and safety of two yellow oil formulations in patients with OA of the knee. Methods This prospective, randomized, single-blind, active-controlled, noninferiority study enrolled 102 patients with OA of the knee. Eligible patients were randomly assigned to apply either yellow oil formulation 3 (YOF3), yellow oil formulation 4 (YOF4), or indomethacin solution (INDO) topically four times daily for four weeks. Outcomes were assessed on a biweekly basis. The primary efficacy outcome measure was a 100 mm visual analog scale (VAS) of pain, while secondary endpoints included knee function, physical performance assessments, and safety parameters. Modified intention-to-treat and per-protocol analyses were applied. Assessment of noninferiority was done with a prespecified margin of 10 mm for VAS pain. Results Of 102 patients enrolled, 86 completed the study: 29/34 in the YOF3 group, 25/34 in the YOF4 group, and 32/34 in the INDO group. The absolute reduction in VAS pain at the final evaluation was −25.06 ± 13.91, −18.50 ± 16.06, and −23.38 ± 10.05 mm in the YOF3, YOF4, and INDO groups, respectively (p=0.169). Only YOF3 was found to be noninferior to INDO. Other efficacy outcomes were significantly improved in all three groups. All the interventions were well tolerated; no skin rash was observed in any of the three groups. Conclusions YOF3 was shown to be noninferior to INDO in relieving knee pain and should be considered an alternative for the treatment of symptomatic OA of the knee. Further research into the mechanism of action of YOF3 and its long-term efficacy and safety is required.

Clinical Efficacy and Safety of Thai Herbal Formulation-6 in the Treatment of Symptomatic Osteoarthritis of the Knee: A Randomized-Controlled Trial.

Background Osteoarthritis of the knee is the most common form of arthritis. Identifying effective and safe herbal formulations that are locally available is viewed as a priority for sustainable development in a region. This study aimed to evaluate the efficacy and safety of Thai herbal formulation-6 (THF-6) in comparison with oral diclofenac in patients with moderate-to-severe osteoarthritis of the knee. Methods This randomized, double-blind, active-controlled, noninferiority trial randomly assigned patients with osteoarthritis of the knee to receive either THF-6 or diclofenac for four weeks. The primary outcome measure was the change from baseline in knee pain as measured by a 100 mm visual analog scale (VAS). Secondary outcome measures included knee stiffness, a stair climb test, the Knee Injury and Osteoarthritis Outcome Score, and safety parameters. Outcomes were assessed on a biweekly basis. Modified intention-to-treat (MITT) and perprotocol (PP) analyses were applied. Results A total of 200 patients were enrolled of whom 175 (87.5%) were included in the MITT analysis and 153 (76.5%) in the PP analysis. The mean change in VAS pain did not differ between the two groups, and the upper limit of the two-sided 95% confidence interval (CI) for comparison between the two groups was within the prespecified margin of 10 mm for noninferiority (MITT analysis: mean difference = 0.86, 95% CI = -4.39 to 6.10, p=0.748; PP analysis: mean difference = 1.98, 95% CI = -3.61 to 7.56, p=0.486). Significant improvement was observed in all the efficacy parameters in both groups. Dyspepsia was the most common adverse event: 23 patients in the THF-6 group and 28 in the diclofenac group (p=0.417). Conclusions THF-6 offers an alternative to oral diclofenac for the short-term treatment of osteoarthritis of the knee. It was shown to be noninferior to oral diclofenac in relieving knee pain. This trial is registered with ChiCTR-IPR-15007213.

Design, Optimization and Simulation of Knee Pain Relief Device Using Hyperthermia Technology

Hyperthermia has been introduced as a therapeutic method and adjuvant therapy in the treatment of some diseases such as breast and pancreatic cancers. On the other hand, other applications of hyperthermia have been considered. In this article, ways to treat knee pain caused by osteoarthritis, patellar chondromasia, rheumatism, knee infection, etc., have been studied using antenna hyperthermia. For antenna hyperthermia, is using a rectangular microstrip antenna, which is the simplest type of antenna. The antenna considered in this article has conformal conditions and is designed in the shape of a knee structure, to create a suitable knee covering. The antenna considered in this article has conformal conditions and is designed in the shape of a knee structure, to create a suitable knee covering. In addition to the geometric structure of the antenna, which fits the structure of the knee, the resonance frequency of the antenna is in the range of ISM standard frequencies and attempts have been made to place it at 2.4 GHz. On the other hand, to show the thermal pattern created by the antenna, the specific absorption rate of the tissue is investigated and its diagram is simulated by the antenna radiation field.

The temporal effect of intra-articular ozone injections on pain in knee osteoarthritis.

Osteoarthritis (OA) is a most common orthopaedic condition, often complicated by inflammatory features. A systematic search in PubMed, Embase, Google Scholar and Scopus databases (to January 2019) was performed to define the effect obtained in patients with OA of the knee by injections of ozone, on pain and physical function. Six RCTs and 353 patients were included. Recently, an increasing number of physicians have used ozone therapy to alleviate the symptoms of acute and chronic OA of the knee. Ozone can allow greater mobility of the knee joint, pain relief and decrease in effusion. The volume and concentration of ozone injected are different in the various treatment protocols published. The action of ozone is unclear, but it is a promising therapeutic modality capable of impacting, favourably, function and quality of life. The lack of a clear protocol of use is a major limitation, and to date there is no clear evidence of long-term efficacy.

Application of Lateral Wedge in Knee Osteoarthritis for Improving Pain and Quality of Life

OBJECTIVE: To determine the effectiveness of lateral wedge with and without conventionalphysiotherapy in relieving knee pain and quality of life in patients of knee Osteoarthritis.METHODOLOGY: This Randomized controlled study was conducted in Madina Clinics, Faisalabad. Byusing simple random technique 40 patients in range 40-60 years of age with clinically and radiologicallydiagnosed cases of grade II and III were studied, from February to August 2016. Subjects were divided intwo groups with 20 subjects in each group. KOOS knee survey was used for the assessment of Qualityof life.RESULTS: Mean total pain score on baseline of experimental group was 79.95±2.5 while the scoreamongst the control group was 79.95±7.69, after application of lateral wedges along with othertreatments, score after 2nd week was 84.65 ± 2.94 while in control group was 80.25±2.9.97. After 4th weekthe symptoms score in experimental group was 83.00 ± 0.00 while control group was 88.95 ± 2.96. Afterthe 6th week score was 91.5±14.5 of experimental and 81.8±9.5 of control group.These results of insoleWedges is also correlated with a lateral shift in the location of the COP in stance phase. Increase in theknee joint varus moment with insole Wedges suggests that the indication and limitations of laterallywedged insoles in general should be analysed in detail.CONCLUSION: This study concluded that the lateral wedges were significant in reduction of pain andsymptoms as well as improve the quality of life.

Systematic Review and Meta-Analysis of 12 Randomized Controlled Trials Evaluating the Efficacy of Invasive Radiofrequency Treatment for Knee Pain and Function.

Radiofrequency (RF) treatment is an invasive and promising procedure in the treatment of osteoarthritis (OA). A meta-analysis based on 12 RCT studies was to investigate whether invasive RF treatment is more effective in relieving knee pain and improving knee function. Relevant studies were searched on database of Pubmed, Embase, EBSCO, Cochrane library, Wanfang digital database, VIP database, and CNKI up to January 2018. A total of 841 participants from 12 publications were included. The weighted mean difference (WMD) and the corresponding 95% CIs were used to evaluate the difference in pain scores and OKS/WOMAC scores between RF treatment and control groups. The statistical analysis was performed by Stata 12.0. The pain scores (VAS) in the RF group were lower than those in the conservative treatment group after 1 week (WMD -1.77, 95% CI -2.93 to -0.61, P<0.01), 1 month (WMD -1.40, 95% CI -1.98 to -0.82, P<0.01), and 3 months (WMD -1.32, 95% CI -2.27 to -0.37, P<0.01) of treatment, while there was no significant improvement in knee function. In subgroup analyses by site of radiofrequency, RF mode showed some discrepancies in the WMD of VAS between the treatment and control groups. In addition, subgroup analysis and meta-regression showed that the efficacy of RF treatment for reducing pain is reversely related to female ratio, and we did not find any surgery-related adverse reactions. RF treatment significantly reduces the knee pain, but rarely improves the knee joint function. Radiofrequency ablation has better efficacy than pulsed radiofrequency ablation in reducing pain. Furthermore, subgroup analysis and meta-regression suggested that women are more sensitive to RF treatment than men.

The role of arthroscopic release of gluteal muscle contracture in improving patellofemoral instability

BackgroundGluteal muscle contracture (GMC) is a notable problem in some developing countries and includes features such as a snapping sound of the hip, abnormal gait, and unusual posture when patients squat with the knees together. Arthroscopic release can not only resolve symptoms, as previously reported, but can also greatly improve accompanying patellofemoral instability. This study was conducted to evaluate the effect of arthroscopic release of GMC on patellofemoral instability and its underlying mechanism.MethodsA total of nearly 500 patients who underwent arthroscopic release of GMC over 2.5 years were filtered, and 54 patients were enrolled in the study. The selected research subjects all had combined patellofemoral instability preoperatively. The Lysholm scores and CT scans of the knee were evaluated pre- and postoperatively.ResultsThe mean follow-up time was 12.2 months. All of the surveyed patients had satisfactory clinical outcomes for hip snapping sounds and abnormal gait. In addition, a significant difference (p < 0.05) was observed between pre- and postoperative Lysholm scores, along with significant knee pain relief. Furthermore, the changes in CT scan parameters were significant as well. The average patellar tilt angle (PTA), patellofemoral index (PFI), and lateral patellar displacement (LPD) were obviously decreased (p < 0.05) after the release. Conversely, the mean lateral patellofemoral angle (LPFA) showed a clear difference (p < 0.05) between preoperative and postoperative CT examinations.ConclusionsArthroscopic release of GMC can reduce the tilt and lateral shift of the patella and enhance its stability due to the release of the iliotibial band.

Yoga for Aromatase Inhibitor-related Knee Pain Relief in Breast Cancer Patients

Yoga for Aromatase Inhibitor-related Knee Pain Relief in Breast Cancer Patients

Antibiotic-impregnated articulating cement spacer maintained for 7 years in situ for two-stage primary total knee arthroplasty: a case report

BackgroundAntibiotic-impregnated articulating cement spacers can maintain interim joint motion with the potential to enhance functional status and improve patient satisfaction. Articular surfaces with cement against cement have raised concerns regarding mechanical complications and cement debris during knee motion. However, long-term clinical conditions regarding these concerns are not well addressed.Case presentationWe report a case in which articulating cement spacers were maintained in situ for 7 years. The patient had severe left knee pain with an ankylosing knee and severe tricompartmental arthritis due to tuberculous infection. We planned to perform one- or two-stage primary total knee arthroplasty (TKA), depending on the presence of infection. Persistent osteomyelitis was found intraoperatively. The second-stage TKA was delayed on the patient’s request. As the patient was satisfied with the improved knee function and pain relief after using articulating cement spacers. No symptom or sign that suggested recurrent infection or systemic toxicity was found during the 7-year follow-up. However, it seemed that the bone loss progressed insidiously. At the 7-year follow-up, a broken articulating cement spacer and medial femoral condylar fracture were found. The second-stage TKA was performed, and a considerable amount of bone loss surrounded by dense granulation tissue was observed intraoperatively. Excisional biopsy of the tissue revealed chronic foreign body reaction with infiltration of giant cells and macrophages.ConclusionAlthough the articular spacers were maintained for 7 years without major complications, regular observation of the development and progress of bone loss was required. Surgeons should take considerable bone loss into account during conversion TKA in patients with a prolonged retention of articulating cement spacers.