Treatment Of Symptomatic Knee Osteoarthritis Research Articles

Is conventional radiofrequency ablation of the superolateral branch, one of the three genicular nerves targeted as standard, necessary or not? A non-inferiority randomized controlled trial.

Radiofrequency ablation is an effective treatment modality in the symptomatic treatment of knee osteoarthritis. Our aim was to compare the efficacy of radiofrequency ablation of the superomedial and inferomedial genicular nerves (2 branches) with the superolateral, superomedial, and inferomedial genicular nerves (3 branches) and to show whether the 2-branch procedure is inferior to the 3-branch procedure. This study is a prospective, randomized, single-blind clinical study. Eligible participants were randomized into 2 groups: group A, which applied the procedure to the superomedial and inferomedial genicular nerves, and group B, which applied it to the superomedial, superolateral and inferomedial genicular nerves. Pain was evaluated with the numerical rating scale, quality of life with the Short Form-36 (SF-36), and disability with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index before, and at 1 and 3 months after the procedure. A total of 41 patients were included. There were no differences between the groups except for the SF-36 physical health sub-score at baseline. A significant improvement was seen in the numeric rating scale (NRS) score, SF-36 sub-scores, WOMAC Index total, as well as pain and physical function scores in both groups, though no significant difference was detected between the groups during follow-up. Although we were unable to establish the noninferiority of conventional radiofrequency ablation (CRFA) applied to 2 branches to CRFA applied to 3 branches, in this trial, significant and similar improvement was observed in NRS, WOMAC total, pain, and physical function and SF-36 scores in both groups.

Efficacy of Platelet-Rich Plasma Versus Hyaluronic Acid in Symptomatic Knee Osteoarthritis

Background: Osteoarthritis (OA) is one of the most common forms of arthritis and leading causes of disability. Intra-articular injection of PRP or steroid may provide benefit for patients suffering from osteoarthritis of knees, preventing, and delaying the need of a larger operative measures as many of the senile patients suffering from OA knee are quite hesitant to undergo any operative measure for the same. Materials and Methods: This was prospective type of study, with randomised selection of the patients for the assessment of outcome of treatment of symptomatic knee osteoarthritis with intra articular injections of PRP or hyaluronic acid. This study was carried out in the department of orthopaedics at our institute. In this study both injections given superolaterally weekly for 3 weeks. Study conducted over 2 years, a total of 50 patients suffering from OA knee were included in the study depending upon inclusion criteria. These patients were randomly selected for injection in a sequential manner i.e., case number 1,3,5,7 and so on sequentially were given injection HA. Case number 2,4,6,8 and so on sequentially were given injection PRP. Patients were evaluated prospectively at enrolment and at 6 weeks, 3 and 6-months follow-up with WOMAC and KSS scores. Results: PRP seems to be more efficient as compared to HA in salvaging knee in osteoarthritis. It can work as a salvaging agent in mild to moderate osteoarthritis of knee. HA injection has been found to be effective only in short term cases. Conclusion: The clinical results of this study show that both these non-surgical modalities (intraarticular injections of PRP or HA) are useful for the treatment of osteoarthritis of knee. Treatment with PRP shows significantly better outcome compared with HA group; with respect to WOMAC and KSS scores.

Comparative study between knee genicular nerve ablation by thermal radiofrequency vs thermal radiofrequency plus alcohol neurolysis for treatment of symptomatic knee osteoarthritis

Comparative study between knee genicular nerve ablation by thermal radiofrequency vs thermal radiofrequency plus alcohol neurolysis for treatment of symptomatic knee osteoarthritis

Bone Healing and Clinical Outcome Following Medial Opening-wedge High Tibial Osteotomy Using Wedge-Shaped Cancellous Allograft.

Medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge-shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. All patients who underwent MOWHTO using a novel wedge-shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre-operative and post-operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow-up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow-up. A paired student's t test was conducted for comparison of differences of the relevant data pre-operatively and post-operatively. A total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from -6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above-mentioned parameters at last follow-up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow-up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS-Knee score and KSS-Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow-up, respectively. Nevertheless, there was no significant difference in ROM between pre-operation and last follow-up (p > 0.05). For MOWHTO, the wedge-shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.

Genicular Artery Embolization for Treatment of Knee Osteoarthritis: Interim Analysis of a Prospective Pilot Trial Including Effect on Serum Osteoarthritis-Associated Biomarkers

PurposeTo characterize the safety, efficacy, and potential role of genicular artery embolization (GAE) as a disease-modifying treatment for symptomatic knee osteoarthritis (OA). Materials and MethodsThis is an interim analysis of a prospective, single-arm clinical trial of patients with symptomatic knee OA who failed conservative therapy for greater than 3 months. Sixteen patients who underwent GAE using 250-μm microspheres and had at least 1 month of follow-up were included. Six patients completed the 12-month follow-up, and 10 patients remain enrolled. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was evaluated at baseline and at 1, 3, and 12 months. Serum and plasma samples were collected for biomarker analysis. The primary end point was the percentage of patients who achieved the minimal clinically important difference (MCID) for WOMAC pain score at 12 months. Baseline and follow-up outcomes were analyzed using the Wilcoxon matched-pairs signed-rank test. ResultsTechnical success of the procedure was 100%, with no major adverse events. The MCID was achieved in 5 of the 6 (83%) patients at 12 months. The mean WOMAC pain score decreased from 8.6 ± 2.7 at baseline to 4.9 ± 2.7 (P = .001), 4.4 ± 2.8 (P < .001), and 4.7 ± 2.7 (P = .094) at 1, 3, and 12 months, respectively. There was a statistically significant decrease in nerve growth factor (NGF) levels at 12 months. The remaining 8 biomarkers showed no significant change at 12 months. ConclusionsGAE is a safe and efficacious treatment for symptomatic knee OA. Decreased NGF levels after GAE may contribute to pain reduction and slowing of cartilage degeneration.

Is Radiofrequency Ablation Superior to Intra-Articular Injections for the Treatment of Symptomatic Knee Osteoarthritis?-A Systematic Review.

The radiofrequency ablation (RFA) is considered a valid, minimally invasive treatment modality for the management of symptomatic knee osteoarthritis (OA). The aim of this study was to compare the outcomes of RFA with that of commonly used intra-articular injections for the persistent knee pain due to OA. Medline/Pubmed and Scopus databases were systematically searched up to April 2023 to identify studies comparing the effect of RFA and intra-articular injections (IAIs) on knee OA. Nine studies including 899 patients fulfilled the eligibility criteria and were included in the systematic review. The RFA procedure was related with improved knee pain relief compared to IAIs at 3-, 6- and 12-month follow-up (p < 0.001). Similarly, functional improvement was greater in RFA treatment than that observed after hyaluronic acid (HA), steroid or platelet-rich plasma (PRP) injections (Visual Analogue Scale p < 0.001, Numeric Rating Scale p = 0.019, Western Ontario and McMaster University Osteoarthritis Index p = 0.012). The overall procedural complication rate of RFA was 10.2% and was higher than steroid (p = 0.023) and PRP (p = 0.017) injections. However, no severe adverse events were reported. For patients with symptomatic knee OA, RFA seems to be more effective than IAIs in alleviating pain and improving joint function, despite the relatively higher incidence of non-serious adverse events. However, due to the limited number of studies and patients, this result should be interpreted with caution and not be generalized to the entire knee OA population.

SP26. Efficacy of Microfragmented Adipose Tissue for Treatment of Symptomatic Knee Osteoarthritis: A Randomized, Placebo-controlled Study

SP26. Efficacy of Microfragmented Adipose Tissue for Treatment of Symptomatic Knee Osteoarthritis: A Randomized, Placebo-controlled Study

Surgical interventions for symptomatic knee osteoarthritis: a network meta-analysis of randomized control trials

BackgroundMultiple surgical interventions exist for the treatment of symptomatic knee osteoarthritis, but the surgeon and patient may often have difficulty deciding which interventions are the best option.MethodsWe conducted a systematic review to identify randomized clinical trials (RCTs) that compared complications, revisions, reoperations, and functional outcomes among TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty), HTO (high tibial osteotomy), BCA (bicompartmental knee arthroplasty), BIU (bi-unicompartmental knee arthroplasty), and KJD (knee joint distraction). The PubMed, Embase, and Cochrane databases were reviewed for all studies comparing two or more surgical interventions. Direct-comparison meta-analysis and network meta-analysis (NMA) were performed to combine direct and indirect evidence. The risk of bias was assessed using the revised Cochrane risk of bias tool for RCTs.ResultsThis NMA and systematic review included 21 studies (17 RCTs), with a total of 1749 patients. The overall risk-of-bias assessment of the RCTs revealed that 7 studies had low risk, 5 had some concerns, and 9 had high risk. SUCRA (the surface under the cumulative ranking curve) rankings revealed that KJD had the greatest risk of appearing postoperative complications, revisions, and reoperations, and UKA or TKA had the lowest risk. The majority of comparisons among various treatments showed no difference for functional outcomes.ConclusionEach surgical intervention is noninferior to other treatments in functional outcomes, but UKA and TKA are better options to treat OA according to SUCRA rankings by comparing complications, revisions, and reoperations. KJD is an imperfect option for treating OA. Other treatments should be carefully considered for each patient in accordance with their actual conditions. However, this conclusion is limited by the selection of reviewed publications and individual variation of surgical indications for patients.Trial registrationThis study was registered with Research Registry (reviewregistry1395).

Evaluation of S201086/GLPG1972, an ADAMTS-5 inhibitor, for the treatment of knee osteoarthritis in ROCCELLA: a phase 2 randomized clinical trial

To evaluate the efficacy and safety of the anti-catabolic ADAMTS-5 inhibitor S201086/GLPG1972 for the treatment of symptomatic knee osteoarthritis. ROCCELLA (NCT03595618) was a randomized, double-blind, placebo-controlled, dose-ranging, phase 2 trial in adults (aged 40-75 years) with knee osteoarthritis. Participants had moderate-to-severe pain in the target knee, Kellgren-Lawrence grade 2 or 3 and Osteoarthritis Research Society International joint space narrowing (grade 1 or 2). Participants were randomized 1:1:1:1 to once-daily oral S201086/GLPG1972 75, 150 or 300mg, or placebo for 52 weeks. The primary endpoint was change from baseline to week 52 in central medial femorotibial compartment (cMFTC) cartilage thickness assessed quantitatively by magnetic resonance imaging. Secondary endpoints included change from baseline to week 52 in radiographic joint space width, Western Ontario and McMaster Universities Osteoarthritis Index total and subscores, and pain (visual analogue scale). Treatment-emergent adverse events (TEAEs) were also recorded. Overall, 932 participants were enrolled. No significant differences in cMFTC cartilage loss were observed between placebo and S201086/GLPG1972 therapeutic groups: placebo vs 75mg, P=0.165; vs 150mg, P=0.939; vs 300mg, P=0.682. No significant differences in any of the secondary endpoints were observed between placebo and treatment groups. Similar proportions of participants across treatment groups experienced TEAEs. Despite enrolment of participants who experienced substantial cartilage loss over 52 weeks, during the same time period, S201086/GLPG1972 did not significantly reduce rates of cartilage loss or modify symptoms in adults with symptomatic knee osteoarthritis.

Platelet-rich plasma is similar to platelet-rich plasma plus hyaluronic acid for the treatment of knee osteoarthritis at 2 years: a randomized controlled trial

IntroductionAutologous platelet-rich plasma (PRP) and hyaluronic acid (HA) are common treatments for knee osteoarthritis (OA). Several studies have demonstrated PRP as a safe and effective treatment for OA and, in some studies, produces a better outcome than HA. ObjectiveThe primary objective of this study was to determine if HA injected with PRP would improve the efficacy of treatment of symptomatic knee OA compared to PRP alone. We hypothesized that the addition of HA would improve the efficacy of (PRP). MethodsA total of 64 participants with Kellgren-Lawrence (KL) Grades 1 to 4 knee OA were randomized into 2 groups and scheduled to receive 3-injections. Group 1 [PRP] received injections of PRP. Group 2 [HA+PRP] received the same treatment, with an additional HA injection for the first 2 injections. Both groups were blindfolded for the first 2 injections. To evaluate the efficacy of the regimen, participants completed patient reported outcome measures (PROMs). PROMs were completed prior to injections and at 1, 3, 6, 12, 18, and 24 months after the final injection. ResultsParticipants in both groups felt pain consistent with standard-of-care HA injection regimens with no difference in perceived pain. No infections or complications were observed. All PROM scores demonstrated improvement over baseline from 1-24 months post injections. There were no statistically significant differences between the groups. ConclusionsFor the treatment of OA, PRP alone or PRP concomitantly with HA performed similarly out to 24 months. PRP in combination with HA was not superior to PRP alone.

Carboplasty, a Simple Tibial Marrow Technique for Knee Osteoarthritis: A Placebo-Controlled Randomized Trial.

Carboplasty is a new minimally invasive technique for knee osteoarthritis (OA) that consists of injecting tibial marrow aspirate into the bone-cartilage interface as well as intra-articularly. To compare the clinical and imaging outcomes, as well as the safety, of carboplasty for symptomatic knee OA in a placebo-controlled trial. Randomized controlled trial; Level of evidence, 1. The authors conducted a randomized controlled trial to compare carboplasty with placebo for the treatment of symptomatic knee OA. Patients who had failed medical treatment and had bone edema on magnetic resonance imaging (MRI) were randomized in a 1:1 ratio to carboplasty or placebo. The primary outcome of the study was the Numeric Pain Rating Scale (NPRS) for the knee at 1 year (scores range from 0 to 10, with a higher score indicating worse pain). Secondary outcomes were the Knee injury and Osteoarthritis Outcome Score (KOOS), treatment responder rate (based on achieving the minimal clinically important difference of the NPRS), MRI bone edema reduction, and treatment safety. In total, 50 patients (25 carboplasty vs 25 placebo) were enrolled and followed up with for an average of 18 months (range, 14-24 months). The average NPRS at baseline decreased from 7.1 ± 0.9 to 2.9 ± 2.1 (P < .001) at 1 year in the carboplasty group and from 7.7 ± 0.9 to 4.9 ± 2.2 (P < .001) in the placebo group. On average, patients after carboplasty improved 60% from their initial NPRS, and patients after placebo improved 37% (P = .003). Patients had a statistically significantly greater improvement from baseline in all KOOS subscales in the carboplasty group compared with the placebo group (P < .001). The responder rates were 96% for carboplasty and 76% for placebo (P = .098). Bone edema was reduced in 72% of patients in the carboplasty group and 44% of patients in the placebo group (P = .045). Neither group had adverse events related to treatment. Carboplasty resulted in greater pain reduction, a significantly greater improvement in all KOOS subscales, and a similar safety profile compared with placebo in patients with symptomatic knee OA and bone edema. ISRCTN69838191 (ISRCT Registry).

A randomized, double-blind placebo-controlled phase I clinical study on safety and efficacy of the G-Rup® syrup (a mixture of ginger extract and honey) in symptomatic treatment of knee osteoarthritis.

Present study evaluated the safety profile and efficacy of G-Rup® syrup (100 mg/ml ginger extract plus 150 mg/ml honey) in symptomatic treatment of knee osteoarthritis (OA). Patients diagnosed with knee OA were randomly assigned (1:1) to receive either of a 30 ml twice daily regimen of G-Rup® syrup or placebo over a 12-week period. Primary endpoints of the study comprised of an improvement in the joint's stiffness, physical functioning and pain score, assessed by WOMAC questionnaire and the visual analog scale (VAS). Secondary objectives comprised of safety and tolerability of the syrup by patients. The 30 ml twice-daily regimen of G-Rup® syrup was safe and well tolerated by patients. Moreover, in whole studied time points, treatment with G-Rup® syrup could significantly Power the VAS score (p< 0.001) whereas improving WOMAC total score (p< 0.001) and pain (p< 0.001), physical functioning (p< 0.001), and stiffness sub-scores (p= 0.006) compared to the placebo receiving group. Based on obtained results, the G-Rup® syrup, composed of a combination of honey and ginger, may be a proper supplementary choice, along with routine therapeutic regimens, for improvement of symptomatic treatment of OA.

Combined subchondral and intra-articular injections ofbone marrow aspirate concentrate provide stable results up to 24months.

The aim of this study was to evaluate the clinical and imaging findings up to 24months of follow-up in patients treated with combined subchondral and intra-articular bone marrow aspirate concentrate (BMAC) injections for the treatment of knee osteoarthritis (OA). Thirty consecutive patients (19 males, 11 females) aged between 40 and 75years (mean age 56.4 ± 8.1years) with unilateral symptomatic knee OA (Kellgren-Lawrence 2-3) were included in the study. Patients were treated with combined intra-articular and subchondral bone BMAC injections (total 9ml) under fluoroscopic control. IKDC subjective score, VAS for pain, KOOS, and EQ-VAS were prospectively evaluated up to 24months. Radiographs were performed at baseline and at 24months after the procedure. MRI was evaluated with the WORMS score at baseline, 6-12months, and 24months of follow-up. The statistical analysis was performed using SPSS v.19.0 and for all tests p < 0.05 was considered significant. No major complications and a 13% failure rate were reported. The IKDC subjective score remained stable from 62.6 ± 19.4 at 12months to 63.4 ± 17.1 at 24months (both p < 0.0005 compared to baseline, 40.5 ± 12.5). Similar improvements were reported for all KOOS subscales, while EQ-VAS did not report any significant improvement. VAS pain worsened from 3.0 ± 1.9 at 12months to 4.4 ± 1.8 at the final follow-up (p = 0.0001), although remaining lower compared to the baseline value of 6.3 ± 1.8 (p = 0.002). The radiographic evaluation did not reveal signs of improvement or deterioration of the OA grade. The MRI findings showed a worsening in marginal osteophytes and synovitis, but a significant reduction of bone marrow edema at 24months (p < 0.0005). Combined intra-articular and subchondral BMAC injections provided clinical and imaging benefits up to 24months for the treatment of symptomatic knee OA, with durable clinical results, a low failure rate, and a significant reduction of bone marrow edema.

Efficacy and safety of oral Nigella sativa oil for symptomatic treatment of knee osteoarthritis: A double-blind, randomized, placebo-controlled clinical trial

Background and purposeThe oil of Nigella sativa (NS) seeds has analgesic and anti-inflammatory effects. Therefore, the efficacy and safety of NS oil in the treatment of knee osteoarthritis were evaluated. Materials and methodsOne hundred and sixteen patients aged 50–70 years were randomly assigned to take 2.5 mL NS oil (N = 58) or placebo (N = 58) orally every 8 h for 1 month. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) was the primary outcome measure and Visual Analog Scale (VAS) for pain, number of 500 mg acetaminophen tablets taken per day during the trial, patients’ satisfaction with the interventions, complete blood count and the blood levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, creatinine and blood urea nitrogen were the secondary outcome measures. ResultsFifty two and 54 patients respectively in the NS oil and placebo groups completed the study. The VAS scores were decreased by 33.96 ± 17.04% (NS oil group) and 9.21 ± 0.32% (placebo group) (p < 0.001), and WOMAC total scores were decreased by 27.72 ± 18.61% (NS oil group) and 1.34 ± 2.31% (placebo group) (p < 0.001) compared to baseline. The NS oil reduced the dose of acetaminophen significantly compared with the placebo (p = 0.001). The patients were significantly more satisfied with the NS oil than the placebo (p < 0.001). The NS oil had no significant effect on the other variables. There was no side effect. ConclusionOral NS oil safely reduces the osteoarthritis symptoms and analgesic dose in the knee osteoarthritis patients.

Prospective double-blind randomised controlled trial protocol comparing bone marrow aspirate concentrate intra-articular injection combined with subchondral injection versus intra-articular injection alone for the treatment of symptomatic knee osteoarthritis

IntroductionSubchondral and intra-articular injections of bone marrow aspirate concentrate (BMAC) showed promising results for knee osteoarthritis (OA) patients. To date, there is no evidence to demonstrate whether the combination of...

Paper 14: Leukocyte-Poor Platelet Rich Plasma versus Leukocyte-Poor Platelet Rich Plasma Plus Hyaluronic Acid for the Treatment of Symptomatic Knee Osteoarthritis: A Prospective, Randomized Control Trial with 2 Year Follow Up

Objectives:The main objective of this study was to determine if hyaluronic acid (HA) injected at the same time as leukocyte-poor platelet rich plasma LP-PRP would improve the performance compared to LP-PRP alone in the treatment of symptomatic knee osteoarthritis. We hypothesized that the addition of hyaluronic acid would improve the efficacy of LP-PRP.Methods:Patients between the ages of 30 and 80 who had symptomatic Kellgren-Lawrence grades 1-4 were eligible for the study. Patients were offered enrollment and screened with inclusion and exclusion criteria. The participants were randomized into two study groups and scheduled to receive a three-injection series. Group 1 [LP-PRP] received 3 intra-articularinjections of LP-PRP dosed at one week intervals. Group 2 [LP-PRP/HA] received 3 intra-articular injections of LP-PRP dosed at one week intervals, with hyaluronic acid (Hymovis) injected concomitantly for the first two injections. The Arthrex Autologous Conditioned Plasma system was used to prepare all LP-PRP injections. Participants were blinded to injection randomization and wore a blind fold for the first two injections. Participants completed patient reported outcome questionnaires prior to their injections and at 1, 3, 6, 12, 18, and 24 months after the final injection. The questionnaires included the Western Ontario and McMaster Universitys Osteoarthritis Index (WOMAC), International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS).Results:The study population included 63 total subjects, 32 subjects were randomized to Group 1 (ACP) with average age 55.8 +/- 11.4, 31 subjects were randomized to group 2 (ACP+HA) with average age 60.4 +/- 9.0. Both groups demonstrated improvement over baseline at 1 and 3 months, with improvement plateauing at 3 months. Both groups demonstrated improvement over baseline out to 24 months. The LP-PRP/HA group demonstrated increased improvement compared to group 1 at 1 and 3 months but consistently trended down in both the WOMAC, IKDC, and KOOS scores however statistical significance was not reached. The LP-PRP groups improvement was consistent until the 18 month time point. Complete patient reported outcome data is included in Table 1. Change in WOMAC, IKDC and KOOS scores over time are represented in Figures 1, 2, and 3 respectively.Conclusions:Both groups demonstrated improvement over baseline at 1 and 3 months, with improvement plateauing at 3months. Both groups demonstrated improvement over baseline out to 24 months. The LP-PRP/HA group demonstrated increased improvement compared to the LP-PRP group at 1 and 3 months, however statistical significance was not reached and the improvement diminished after the 12 month time point. The LP-PRP group did not see a diminishing improvement until the 18 month time point.Figure 1.IKDCScore.Figure 2.WOMAC Score.Figure 3.KOOS Scores.

Comparison of the pain-killing effects of leech therapy versus physiotherapy in patients with knee osteoarthritis: A double-blind randomized clinical trial

Background: Knee osteoarthritis is a debilitating disease that affects a large proportion of the elderly population. Treatments for this disease are mostly based on symptomatic management. The primary treatments are physiotherapy, which is associated with high costs, and nonsteroidal antiinflammatory drugs (NSAIDs), which have serious side effects, including gastrointestinal bleeding, renal failure, and cardiovascular complications. This study aimed to assess the effects of leech therapy versus physiotherapy as a noninvasive method in the treatment of knee osteoarthritis. Methods: This double-blind randomized clinical trial was performed on 98 patients with osteoarthritis of the knee. The patients were randomly divided into two groups: leech therapy or physiotherapy. The analgesic effects and recovery of the patients were assessed using the KOOS questionnaire 90 days after the beginning of the study. Student's t-test, the Wilcoxon test, and the Mann–Whitney U test were used for comparisons between the two groups. Results: The mean age of the patients was 61.03 +/- 10.99 years. The KOOS ADL and KOOS sport/recreational activities decreased significantly in the leech therapy group (P &lt; 0.05). Additionally, the mean KOOS QOL after treatment was significantly lower than it was before treatment (P &lt; 0.001). In the physiotherapy group, the KOOS pain score increased significantly after treatment (25.86 +/- 18.77 vs. 31.60 +/- 11.71; P = 0.008). The KOOS ADL score also showed a significant increase (24.59 +/- 18.55 vs. 35.74 +/- 15.83; P &lt; 0.001). In addition, the median KOOS sport/recreational activities and KOOS QOL increased significantly in the physiotherapy group (P &lt; 0.05). All of the factors in the physiotherapy group had significantly better prognoses than those in the leech salivary therapy group (P &lt; 0.05). Conclusion: This study failed to identify any therapeutic or remedial effects of leech therapy on pain and symptoms in the symptomatic treatment of knee osteoarthritis. Future studies using more leeches and examining the therapeutic effects over a shorter period of time are recommended to more fully evaluate the effectiveness of leech therapy.

SAFETY OF GENICULAR ARTERY EMBOLIZATION FOR THE TREATMENT OF KNEE OSTEOARTHRITIS: DATA FROM THE NEO TRIAL.

Purpose: To describe the frequency and type of adverse events (AEs) that occurred during a sham controlled trial evaluating the efficacy of genicular artery embolization (GAE) for the treatment of symptomatic knee osteoarthritis (OA).

Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears).

Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears).

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes.

Background:Intra-articular infiltration of platelet-rich plasma (PRP) is an alternative therapeutic option to classic hyaluronic acid for the treatment of symptomatic knee osteoarthritis (KOA). However, variation in preparation methods and quality assessment of PRP makes the study of its real clinical efficacy difficult.Purpose:To (1) evaluate the clinical efficacy of a characterized PRP product prepared in a standardized manner and in a closed-system for the treatment of KOA and to (2) evaluate the association of the clinical response to PRP-related variables.Study Design:Case series; Level of evidence, 4.Methods:We recruited 130 patients with nonoperative KOA and evaluated them for 1 year. PRP was prepared from a donation of autologous blood, obtaining 3 aliquots of approximately 10mL of product, which were frozen, allowing platelet disruption, platelet factor release, and long-term storage, until administration. Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions. Complete blood count was performed on the whole-blood sample and the processed PRP before freezing it, for product quality assessment. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and basic satisfaction scale at 3 months, 6 months, and 1 year after intervention.Results:Quality assessment confirmed a leukocyte-poor PRP product (white blood cell count, 0.09 ± 0.09 × 109/L) with a high platelet purity (platelet count, 630.86 ± 191.75 × 109/L). WOMAC scores improved, and basic satisfaction was achieved in 70% of patients. No adverse events were reported. No correlations were observed between PRP quality parameters and clinical results. PRP complete treatment production costs were €108/US$125 (€36/US$41.6 per injection).Conclusion:This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA. This technique was safe and affordable and ensured consecutive infiltrations with the same product to each patient.