Total WOMAC Score Research Articles

The cross-sectional and longitudinal associations of dietary patterns with knee symptoms and MRI detected structure in patients with knee osteoarthritis

To examine the cross-sectional and longitudinal associations of dietary patterns with knee symptoms and structures in patients with knee osteoarthritis (OA). Participants with symptomatic knee OA were recruited from a randomised, placebo-controlled trial conducted in Tasmania (N=259) and Victoria (N=133). Diet was assessed by the Anti-Cancer Council of Victoria food frequency questionnaire. Factor analysis was used to identify dietary patterns. Knee symptoms were assessed using Western Ontario and McMaster Universities Arthritis Index (WOMAC) and structures using MRI. Multivariable linear regressions were used to examine associations. Three dietary patterns ("high-fat", "healthy" and "mixed") were identified in whole sample. Participants with higher "healthy pattern" score had lower total WOMAC, pain, function and stiffness scores at baseline but the associations were not significant over 24 months. Three ("western", "vegetable and meat" and "mediterranean") and two ("processed" and "vegetable") patterns were identified in Tasmania and Victoria, respectively. Cross-sectionally, only "mediterranean pattern" and "vegetable pattern" scores were significantly and negatively associated with total WOMAC or function scores. Longitudinally, participants with higher "western pattern" had worsening function (β: 0.35, 95%CI: 0.03, 0.67) and total WOMAC (β: 0.40, 95%CI: 0.07, 0.72) scores; furthermore, "vegetable pattern" was associated with decreased WOMAC stiffness score (β:-0.47, 95%CI:-0.93,-0.02). In contrast, dietary patterns were largely not associated with structural changes. Some healthy dietary patterns were associated with reduced joint symptoms but dietary patterns were not associated with joint structure in this sample with knee OA. Further studies are required to confirm these findings.

Association of serum uric acid with clinical and radiological severity of knee osteoarthritis in non-gouty patients

BackgroundA growing body of evidence suggested that uric acid (UA) may contribute in the pathways underlying osteoarthritis (OA) pathogenesis; however, studies that investigated the relationship between UA and OA emerged inconclusive results. The purpose of the study was to explore the association of serum uric acid (sUA) levels with clinical severity, radiological severity of knee osteoarthritis (KOA) based on Kellgren-Lawrence (KL) grading system, and MRI changes in non-gouty patients.ResultsWOMAC scores: pain, stiffness, function, and total score are significantly higher in H-sUA group than L-sUA group (p = 0.004, p = 0.019, p = 0.018, p = 0.008 respectively). Joint space width (JSW) is significantly narrower in H-sUA group than L-sUA group (p = 0.013). H-sUA group had more frequent KL grade 4 (p < 0.001), osteophytes grade 4 (p < 0.001), focal bone erosion (p < 0.001), bone marrow lesions (p = 0.023), and synovitis (p = 0.011) than L-sUA group. Female KOA patients in H-sUA group had significantly higher pain, stiffness, and function and total WOMAC scores than L-sUA group (p = 0.003, p = 0.015, p = 0.008, p = 0.004), more frequently had KL grade 4 and osteophytes grade 4 (p = 0.003, p < 0.001), significantly narrower JSW (p = 0.016), more frequently show focal bone erosion (p = 0.002), bone marrow lesions (p = 0.019), and synovitis (p = 0.004) than L-sUA group. In regression analysis, female sex (p = 0.035), duration of KOA (p = 0.031), and sUA level (p = 0.025) were associated with KL severity. For female patients with KOA, KL severity is associated with duration of KOA (p = 0.045) and sUA (p = 0.009).ConclusionHigher sUA level is associated with higher clinical severity, higher radiographic KL grades, and more frequent MRI findings in patients with primary KOA patients. Our results also indicated that sUA level was significantly associated with KOA severity in female patients, but not in male patients. More studies are warranted to explore whether the two conditions exist simultaneously or there is a direct causal relationship between the two conditions.

Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup.

Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

The effect of oral low molecular weight liquid hyaluronic acid combination with glucosamine and chondroitin on knee osteoarthritis patients with mild knee pain: An 8-week randomized double-blind placebo-controlled trial.

Background:The popularity of dietary supplements for knee osteoarthritis (OA) management is on the rise; however, their effects are still debated.Methods:This study aimed to investigate the effect of an oral low molecular weight liquid hyaluronic acid supplement in the treatment of knee OA patients with mild knee pain (visual analogue scale [VAS] ≤ 3) in Taiwan population. This was a randomized, double-blind, placebo-controlled study. Forty-seven subjects were enrolled and randomly allocated to either the A+HA or the placebo groups. The subjects were required to drink a bottle contained 20 mL of A+HA or placebo daily throughout an 8-week study period. The efficacy was assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 36-item Short Form Survey (SF-36).Results:At Week 8, significant reductions from baseline in the WOMAC pain (–2.6 ± 1.68, P < .0001), stiffness (–1.2 ± 1.50, P = .007), physical function (–5.8 ± 4.39, P < .0001), and total (–9.4 ± 5.82, P < .0001) scores were observed in the A+HA group but not in the placebo group. Significant differences in the mean change of WOMAC scores from baseline at Week 8 between groups were detected (P < .01). At Week 8, the A+HA group also showed significant improvements in SF-36 physical functioning (2.7 ± 3.10, P = .001) and bodily pain (0.7 ± 1.50, P < .05) domains. Although the A+HA group had a higher increase in the SF-36 total score than the placebo group but the difference was not statistically significant (2.1 ± 12.75 vs 0.3 ± 19.66, P = .12).Conclusions:Oral administration of low molecular weight liquid HA appeared to be effective for knee OA patients with mild knee pain (VAS ≤ 3) in the relief of knee OA symptoms, particularly in pain and physical function.Clinical Trial Registration: NCT04352322.

The Combination of Exercise and Manual Therapy Versus Exercise Alone in Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Clinical Trial.

Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic surgeries in the lower extremity. However, patient dissatisfaction and functional disability are mostly experienced because of pain and limited range of motion (ROM). Although manual therapy is commonly implemented to improve ROM and modulate pain in the management of musculoskeletal disorders, there is a lack of evidence about its clinical effectiveness on postoperative TKA rehabilitation. To investigate the effectiveness of an exercise program combined with manual therapy compared with an exercise program only for pain, ROM, function, quality of life, and patient satisfaction outcomes. A randomized controlled clinical trial. Rehabilitation unit of a university hospital. Forty-two patients (68.45 ± 6.3 years) scheduled for unilateral TKA as a treatment of severe osteoarthritis. Joint and soft tissue mobilizations in addition to exercise therapy were provided to the mobilization group (n = 21) while the control group received exercise therapy only (n = 21). The outcome measures were numeric pain-rating scale, knee ROMs, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, 10-meter walk test (10MWT), 5-times sit to stand test (5SST), and Short Form-12 (SF-12). Improvements in pain outcomes were significantly higher in the mobilization group than in the control group (P = .001, F [3, 33] = 7.06) and the between-group difference in change score was 1.3 points (P = .001). Although the between-group difference in change score was 12.8° for knee flexion at 2 months (P = .001), the overall group-by-time interactions were not significant for flexion and extension ROMs (P = .175, F [3, 33] = 1.75 and P = .57, F [2, 34] = 0.56, respectively). Additionally, there were statistically meaningful group-by-time interactions on total WOMAC score (P = .006, F [2, 34] = 5.29), 10MWT (P = .002, F [3, 33] = 5.98), and SF-12 mental component summary (P = .01, F [2, 34] = 4.92) favoring the mobilization group. Also, patient satisfaction was higher in the mobilization group (P = .02). A structured exercise program combined with manual therapy can be more beneficial in improving pain, function, and patient satisfaction compared to exercise program alone for postoperative TKA patients.

Bioavailable turmeric extract for knee osteoarthritis: a randomized, non-inferiority trial versus paracetamol

BackgroundTo compare the efficacy and safety of bioavailable turmeric extract versus paracetamol in patients with knee osteoarthritis (OA).MethodsIn this randomized, non-inferiority, controlled clinical study, patients of knee OA were randomized to receive bioavailable turmeric extract (BCM-95®) 500 mg capsule two times daily or paracetamol 650 mg tablet three times daily for 6 weeks. The primary outcome measure was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. The secondary outcome measures were WOMAC total, WOMAC stiffness, and WOMAC physical function scores. Responder analysis of individual patients at different levels (≥ 20%, ≥ 50%, and ≥ 70%) for WOMAC score was calculated. TNF alpha and CRP levels were evaluated and adverse events (AE) were also recorded.ResultsSeventy-one and seventy-three knee OA patients, respectively in bioavailable turmeric extract and paracetamol groups, completed the study. Non-inferiority (equivalence) test showed that WOMAC scores were equivalent in both the groups (p value < 0.05) in all the domains within the equivalence limit defined by effect size (Cohen’s d) of 0.5 whereas CRP and TNF-α were better reduced with turmeric extract than paracetamol. After 6 weeks of treatment, WOMAC total score, pain, stiffness, and function scores got a significant improvement of 23.59, 32.09, 28.5, and 20.25% respectively with turmeric extract. In the turmeric extract group, 18% of patients got more than 50% improvement and 3% of patients got more than 70% improvement in WOMAC pain and function/stiffness score and none of the patients in the paracetamol group met the criteria. CRP and TNF-α got significantly reduced (37.21 and 74.81% respectively) in the turmeric extract group. Adverse events reported were mild and comparatively less in the turmeric extract group (5.48%) than in the paracetamol group (12.68%).ConclusionThe results of the study suggest that bioavailable turmeric extract is as effective as paracetamol in reducing pain and other symptoms of knee osteoarthritis and found to be safe and more effective in reducing CRP and TNF-α.Trial registrationClinical Trials Registry – India CTRI/2017/02/007962. Registered on 27 February 2017

Association between Baseline Osteoarthritic Features on MR Imaging and Clinical Outcome after Genicular Artery Embolization for Knee Osteoarthritis

PurposeTo explore the association between baseline osteoarthritis (OA)-related magnetic resonance (MR) imaging features and pain reduction after genicular artery embolization (GAE) in patients with mild-to-moderate symptomatic knee OA resistant to conservative therapy. Materials and MethodsThis was a retrospective analysis of patients with mild-to-moderate symptomatic knee OA treated with GAE using imipenem-cilastatin sodium. The clinical outcome was scored at baseline and 6 months after treatment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). MR images were scored using the MR imaging osteoarthritis knee score. Linear regression was used to evaluate associations of before-treatment MR imaging scores with WOMACpain and WOMACtotal reduction after 6 months. ResultsFifty-four patients (22.2% male; median age, 69.4 years; median WOMACpain at baseline, 12) were evaluated. Of all OA features scored, a higher cartilage full-thickness defect score showed the strongest association with less reduction of both WOMACpain (B,−0.63 [95% confidence interval (CI), −0.91 to −0.34]; P < .001) and WOMACtotal scores (B, −1.77 [95% CI, −2.87 to −0.67]; P < .001) following treatment. The presence of grade 2–3 effusion synovitis (B, −2.99 [95% CI, −5.39 to −0.60]) bone marrow lesions (B, −0.52 [95% CI, −0.86 to −0.19]), osteophytes (B, −0.21 [95% CI, −0.36 to −0.06]), and cartilage defect surface area score (B, −0.25 [95% CI −0.42 to −0.08]) all showed a significant association with less WOMACpain reduction (all P < .05). ConclusionsIn patients with mild-to-moderate symptomatic knee OA treated with GAE, the presence and severity of full-thickness cartilage defects, effusion synovitis, bone marrow lesions, osteophytes, and cartilage surface area scores at baseline are associated with less favorable clinical outcomes at 6 months.

The clinical efficacy of arthroscopic therapy with knee infrapatellar fat pad cell concentrates in treating knee cartilage lesion: a prospective, randomized, and controlled study

IntroductionTo evaluate the clinical efficacy of arthroscopic therapy with infrapatellar fat pad cell concentrates in treating knee cartilage lesions, we conducted a prospective randomized single-blind clinical study of controlled method.MethodsSixty cases from Shanghai Changzheng Hospital from April 2018 to December 2019 were chosen and randomly divided into 2 groups equally. Patients in the experiment group were treated through knee arthroscopy with knee infrapatellar fat pad cell concentrates containing mesenchymal stromal cells, while patients in the control group were treated through regular knee arthroscopic therapy. VAS and WOMAC scores were assessed at pre-operation, and 6 weeks, 12 weeks, 6 months, and 12 months after intervention. MORCART scores were assessed at pre-operation and 12 months after intervention.ResultsTwenty-nine cases in the experiment group and 28 cases in the control group were followed up. No significant difference in VAS, WOMAC, and MOCART scores were found between the two groups before surgery (P > 0.05). The WOMAC total and WOMAC function scores of the experiment group were significantly lower than those of the control group 6 months and 12 months after surgery (P < 0.05). The VAS rest and VAS motion scores of the experiment group were found significantly lower than those of the control group 12 months after surgery (P < 0.05). The MOCART scores of the experiment group were found significantly higher compared with the control group 12 months after surgery (P < 0.05). No significant difference in WOMAC stiffness scores were found between the two groups.ConclusionsThe short-term results of our study are encouraging and demonstrate that knee arthroscopy with infrapatellar fat pad cell concentrates containing mesenchymal stromal cells is safe and provides assistance in reducing pain and improving function in patients with knee cartilage lesions.Trial registrationChiCTR1800015379. Registered on 27 March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25901.

Extracorporeal Shockwave Therapy With a Modified Technique on Tendon and Ligament for Knee Osteoarthritis: A Randomized Controlled Trial.

There have been no definitive guidelines on the treatment method and specific points in the body. The aim of the study was to investigate the effects of extracorporeal shockwave therapy on treating the main tendons and ligaments of knee osteoarthritis. A total of 36 patients with knee osteoarthritis were enrolled in trial and organized into two groups: 3-wk extracorporeal shockwave therapy for the intervention group and 3-wk sham extracorporeal shockwave therapy for control group. Both groups received the same physical therapies: (1) transcutaneous electrical nerve stimulation, (2) magnetic field treatment, and (3) quadricep muscle strength training. Evaluation was performed before the start of treatment, at third week after the start of treatment, and 1 wk after the end of treatment. The study used randomized controlled trials (level of evidence, 1). Eextracorporeal shockwave therapy group had significant improvement in WOMAC pain score, physical function, and total score (mean difference = -2.8, P < 0.001; -5.1, P = 0.02; -8.3, P = 0.004, respectively), Visual Analog Scale score (mean difference = -2.3, P < 0.001), and the distance of 6-min walk test (mean difference = 28.7, P = 0.01) in the 1 wk after the end of treatment. Statistical significance in WOMAC pain, physical function, and total scores (mean difference = -3.0, P = 0.001; -5.6, P = 0.02; -9.3, P = 0.004, respectively) and Visual Analog Scale score (mean difference = -1.2, P = 0.027) was observed between the extracorporeal shockwave therapy group and control group. Extracorporeal shockwave therapy for the tendons and ligaments has clinical benefits for pain and physical function improvement in knee osteoarthritis. In addition, improvement in physical performance was observed in the short-term follow-up.

Influence of increased pain sensitivity on patient-reported outcomes following total knee arthroplasty.

The purpose of this study was to discover whether increased pain sensitivity was associated with postoperative pain and patient-reported outcome measures (PROMs) after total knee arthroplasty (TKA). Pain sensitivity was evaluated preoperatively using a pain sensitivity questionnaire (PSQ). Resting, walking, nighttime, and average pain visual analog scale (VAS) were measured before surgery and 6weeks, 3months, 6months, and 1year after surgery. PROMs were also evaluated based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and patient satisfaction. The association between pain VAS average score, WOMAC total score, and PSQ score (minor, moderate, and total score) was assessed at each stage. There were 59 patients with a high PSQ score (≥ 5.2) and 53 with a low PSQ score (< 5.2). Up to 1year postoperatively, the group with high PSQ scores had higher resting, walking, nighttime, and average pain VAS scores than the group with low scores (all p < 0.05). Worse preoperative WOMAC pain, function, and total scores continued until 1year after surgery in the high-scoring PSQ group (all p < 0.05). The group with low PSQ scores was more satisfied with surgery than the group with high scores (p = 0.027). There was a positive correlation between preoperative PSQ score and pain VAS average score at all time points (all p < 0.05). A relationship between PSQ score and WOMAC total score was also observed (all p < 0.05). Increased pain sensitivity is a factor related to higher postoperative pain levels and inferior PROMs in patients undergoing primary TKA. Case-controlled study, III.

Improved function and strength in patients with knee osteoarthritis as a result of adding a two-day educational program to usual care. Prospective randomized trial

ObjectiveThe primary aim was to quantify the improvements on function and pain of patients with knee osteoarthritis (KOA), short education and low income by a two-day self-management program. Secondary aims were verifying if the program improves clinically relevant measures of weight and strength. DesignA prospective randomized clinical trial was conducted in a tertiary hospital in Brazil with 191 patients with Kellgren & Lawrence grades II and III KOA who were allocated to two groups: control (usual care- CG) and intervention (usual care and two days of an OA self-management program with a multiprofessional team - IG). Western Ontario and McMaster Universities Index (WOMAC), weight, body mass index (BMI), Timed up and go (TUG) and five Times Sit to Stand Test (FTSST) were assessed at baseline, six, 12 and 24 months. ResultsGroups were similar at baseline (p ​> ​0.05). Both groups exhibited improved WOMAC total and subsets scores throughout the study (p ​< ​0.001). However, only IG improved WOMAC total and subsets in all follow-ups above 20% (minimally clinically important difference), with differences in WOMAC pain, function and total scores (p ​= ​0.001, p ​< ​0.001, and p ​< ​0.001, respectively) and best effect sizes at 1 year (0.355, 0.651 and 0.770, respectively). IG group lost weight (p ​< ​0.001) and BMI (p ​< ​0.01). Both groups exhibited improvements in TUG and FTSST (p ​< ​0.001) that remained in all evaluations. FTSST results favored the IG, p ​= ​0.032. ConclusionsAn educational program to patients with KOA, short schooling and low income improves clinically important measures of pain and function.

Treatment of knee osteoarthritis with a new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin: a multicenter, randomized, single-blind, non-inferiority clinical trial

ObjectivesTo compare the efficacy and safety of a new formulation of a fixed dose combination of glucosamine sulfate (GS; 1500 mg) and bovine chondroitin sulfate (CS; 1200 mg) versus the reference product (RP) in patients with knee osteoarthritis (OA).MethodsIn this multicenter, randomized, single-blind trial, 627 patients with knee osteoarthritis (OA)—Kellgren-Lawrence grades 2 or 3 and mean score ≥ 40 mm in the WOMAC pain subscale—were randomized to receive GS/CS or the RP for 24 weeks. The primary efficacy endpoint was the absolute change in WOMAC pain subscale score. The secondary endpoints included the following: WOMAC total and subscale scores, overall assessment of the disease by the patient and the investigator, SF-12 score, OMERACT-OARSI response rate to the treatment, and rescue medication use.ResultsMean reductions of WOMAC pain score were − 35.1 (sd = 23.2) mm in the GS/CS group and − 36.5 (sd = 24.9) mm in the RP group. The difference between the adjusted means of both treatments confirmed the non-inferiority of GS/CS versus the RP. Improvement was observed in pain, stiffness, physical function and total WOMAC score, as well as in overall OA assessment by the patient and the investigator for both groups. No improvement was observed in SF-12. The rate of OMERACT-OARSI responders was 89.4% in GS/CS group and 87.9% in the RP group. Headache and changes in glucose tolerance were the most frequent treatment-related adverse events.ConclusionsThe new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin sulfate was non-inferior to the RP in symptomatic treatment of knee OA, with a high responder rate and good tolerability profile.Trial registrationClinicalTrials.gov; Registration number NCT02830919; Date of registration: July 13, 2016; First randomization date: December 05, 2016).

Assessment of foot posture and related factors in patients with knee osteoarthritis.

Objectives The aim of this study was to compare foot posture between patient and control groups, and to identify factors associated with foot posture abnormality in knee osteoarthritis (OA).Patients and methods This case-control study included a total of 115 patients (26 males, 89 females; mean age: 54.4±9.3 years; range, 29 to 73 years) with OA and 77 healthy controls (20 males, 57 females; mean age: 52.1±8.1 years; range, 32 to 69 years) between May 2019 and July 2019. The participants were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and the Beighton criteria. Radiological assessments were performed using the Kellgren-Lawrence grading, condylar plateau angle, and medial tibiofemoral joint width. The Foot Posture Index-6 (FPI-6) was used for foot posture analysis and three groups were formed as supinated, neutral, and pronated postures.Results Foot posture was significantly different between the patient and control groups (p<0.05). Of the patients with knee OA, significant differences were found in the VAS, WOMAC-pain, WOMAC-physical function, and WOMAC-total (p<0.05) among the foot postures. No significant difference was found among the foot posture groups in terms of the radiological parameters and WOMAC-stiffness (p>0.05). Hypermobility and WOMAC-total scores were significantly associated with foot posture abnormality (p<0.05).ConclusionJoint hypermobility and foot posture are the factors which may influence the clinical characteristics of knee OA. Foot posture and joint hypermobility should be taken into consideration during the examination and management of patients with knee OA.

Participation in a Preoperative Patient Education Session Is a Significant Predictor of Better WOMAC Total Index Score and Higher EQ-5D-5L Health Status Index 1 Year After Total Knee and Hip Arthroplasties: A Retrospective Observational Study.

The aim of the study was to investigate whether patient-specific factors, preoperative patient-reported outcome measures, and participation in a preoperative patient education session significantly predict 1-yr Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) health status index of patients who underwent total hip or knee arthroplasties within an enhanced rehabilitation program. This is a retrospective observational cohort study. The inclusion criteria were met by 676 (373 total hip arthroplasties and 303 total knee arthroplasties) patients. Two multiple regression models were carried out to estimate the contributions of nine potential predictors. Younger age (P = 0.006), higher preoperative EQ-5D-5L index (P = 0.004), lower patient clinical complexity level (P = 0.001), lower preoperative WOMAC total score (P < 0.001), preoperative patient education session (P = 0.004), and submitting for total hip arthroplasty (P < 0.001) were significant predictors of better 1-yr WOMAC total score. Higher preoperative EQ-5D-5L index (P < 0.001), lower patient clinical complexity level classification (P < 0.001), lower preoperative WOMAC total score (P = 0.009), preoperative patient education session (P = 0.04), and submitting for total hip arthroplasty (P = 0.01) were significant predictors of higher 1-yr EQ-5D-5L health status index. Better baseline patient-reported outcome measure scores, less comorbidities, younger age, submitting for total hip arthroplasty, and attending a preoperative patient education session were significant predictors of better WOMAC total scores and higher EQ-5D-5L health status index 1 yr after total hip or total knee arthroplasties.

Efficacy of mesenchymal stromal cells for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials

BackgroundMesenchymal stromal cells (MSCs) are used as an emerging new option for the treatment of knee osteoarthritis (OA). However, their efficacy remains controversial across studies with different doses of MSCs and cell processing methods. We conducted this meta-analysis to assess the efficacy of MSCs in the treatment of knee OA.MethodsRandomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and CNKI (National Knowledge Infrastructure, China) databases were systematically reviewed. The pain level and function improvements were evaluated using visual analog scale (VAS), McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC). The pooled estimate was calculated with weighted mean difference (WMD) with 95% confidence intervals (95%CIs).ResultsNine RCTs involving 476 patients were included in this meta-analysis. The pooled estimate showed that the treatment of MSCs significantly reduced VAS, WOMAC pain, WOMAC stiffness, and WOMAC function scores at a long-term follow-up (12 or 24 months). However, for the IKDC and WOMAC total scores, MSCs also showed significant improvement in these outcomes, although this was not statistically significant when compared to the control.ConclusionBased on the current studies, our results suggested that MSCs were a promising option for the treatment of patients with knee OA. However, considering the potential limitations, more well-performed, large-scale RCTs are needed to verify our findings.

Comparison of intraarticular injection versus radiofrequency neurotomy in knee osteoarthritis.

Background: Multiple modalities are existing for pain management in knee osteoarthritis cases. This study was conducted to compare between the efficacy of genicular nerves radiofrequency ablation versus intraarticular steroid injection in pain management in knee osteoarthritis.Patients and methods: A total of 58 cases with knee osteoarthritis were included and they were divided into 2 equal groups; RF group who underwent radiofrequency for the genicular nerves, and IA group who underwent intraarticular steroid injection. Follow up visits were scheduled after 1week, 2 weeks, 1,2, 3, and 6 months. Both visual analogue score and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed in each visit. Furthermore, patient satisfaction was also recorded.Results: Patient characteristics did not differ significantly between the two groups (p > 0.05). Both VAS and total WOMAC scores were improved in both groups. However, the RF showed better scores at 2-, 3-, and 6- month visits. Satisfaction grade did not differ between the two groups.Conclusion: Both genicular nerve RF and intraarticular steroid injection are safe and efficacious in pain management in knee osteoarthritis cases. Nevertheless, the effect is more prolonged after RF.

Relationship of neuropathic pain component and osteoarthritis stage in patients with knee osteoarthritis

Aim: The aim of this study was to determine the frequency of neuropathic pain (NP) in patients with knee osteoarthritis (OA) and the relationship between knee OA stage and NP degree.Materials and Methods: This study included 63 patients (11 male, 52 female; mean age 62.4 ± 11.9 years; range 40-89 years) who were diagnosed with knee OA according to the American College of Rheumatology between January and May 2019. For all the participants, the knee pain was evaluated with the Visual Analog Scale (VAS), the functional evaluation was performed through Western Ontario and McMaster University (WOMAC) Osteoarthritis Index, and the neuropathic pain (NP) component was evaluated through Pain-DETECT Questionnaire (PDQ). The Kellgren-Lawrence grading system was used to determine radiological severity.Results: Of the total, 18 patients (28.5%) were classified as possible NP and 15 patients (23.5 %) were classified as likely NP. The symptom durations of the patients with final NP diagnosis were longer (p<0.05). The PDQ score was determined to be moderate and positively correlated with the WOMAC subscale scores and total score (pain score: r=0.450, p<0.001; stiffness score: r=0.4011, p=0.001; physical function score: r=0.397, p=0.001; total score: r=0.424, p=0.001). A positive and weak correlation was detected between the knee OA stage and neuropathic pain scores (p<0.05; r: 0.265).Conclusion: This study showed that the underlying cause of knee pain in the significant part of knee-OA patients has the NP component. Knee-OA patients with neuropathic pain component had higher rates of OA-related disability. There was a poor correlation between NP scores and radiographically advanced osteoarthritis symptoms. However, we suggest that further studies should be conducted with larger sample groups, the NP component should be kept in mind and should be included in the treatment plan for the knee-OA patients.

Evaluation of Change in Aceclofenac Usage Pattern in Knee Osteoarthritis Following Viscosupplementation: A Prospective Interventional Study

Introduction: Osteoarthritis (OA) of knee is one of the most common musculoskeletal disorders affecting the elderly population in Asia-Pacific region. Array of diverse treatment options exist including analgesics, Non Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, physical therapy, orthotic devices, structure modifying drugs, Intra-articular viscosupplementation, corticosteroids or Platelet Rich Plasma (PRP) and surgery. Viscosupplementation {Hyaluronic acid (HA)} is said to exert an anti-inflammatory effect and has remained a modality under investigation for a longtime. Aim: To see the change in aceclofenac usage pattern in knee OA following viscosupplementation as a surrogate for efficacy of viscosupplementation related pain relief. Materials and Methods: This study was a prospective interventional study on 60 subjects over duration of 18 months (October 2015 to March 2017). The subjects who were prescribed viscosupplementation (single dose of Intra-articular Hyaluronic Acid (IAHA) High Molecular Weight (HMW) 90 mg/3 mL in the affected knee) were included after satisfying inclusion and exclusion criteria. All the patients were assessed at the baseline, 4, 8 and 12 weeks in terms of Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and quantity of aceclofenac intake post viscosupplementation. Data were entered and analysed in SPSS version 21. Categorical variables were presented in number and percentage while continuous variables were presented as mean±SD and compared using paired t-test across follow-ups. A p-value of ≤0.05 was considered statistically significant. Results: After viscosupplementation there was significant reduction in aceclofenac intake from 3.88±1.46 gm to 1.72±0.75 gm and p-value was &lt;0.0001. There was also improvement in pain as VAS decreased from 6.88±0.98 to 3.97±0.86 (p-value &lt;0.0001) over 12 weeks. Similarly there was functional improvement as WOMAC total score reduced from 46.2±8.45 to 27.53±5.67 after 12 weeks. The p-value was &lt;0.0001 at all the follow-ups. Conclusion: Aceclofenac requirement is decreased and there is improvement in pain and function after viscosupplementation. Viscosupplementation reduces NSAIDs (aceclofenac) usage in OA knee while at the same time reducing pain and improving function.

Combination of platelet-rich plasma and hyaluronic acid in the treatment of moderate and severe osteoarthritis of the knee joint

The study aimed to determine the effectiveness of monthly intra-articular injection of combination of PRP and hyaluronic acid in improvement of outcome of knee OA. It was conducted as open clinical trial on a convenient sample of 17 patients with unilateral or bilateral symptomatic knee OA in rheumatology and orthopedic clinics at Al-Jumhoori Teaching Hospital in Mosul, Iraq during 1st of Jan to 30th Jun, 2018. The patients received intra-articular injection of combination of plate rich plasma (PRP) and hyaluronic acid (HA) monthly for three months. The outcome assessment was carried out 4 weeks after the last injection using WOMAC index. The results revealed that WOMAC index subscales was reduced significantly (p &lt;0.001) after treatment by followings mean differences: 3.88 in pain (95% CI: 3.18-4.58); 1.29 in stiffness (95% CI: 0.85-1.73); 9.29 in physical function (95% CI: 6.70-11.88); and 14.47 in total score (95% CI: 11.20-17.73). The intervention effect size were as follows: 1.23 in pain; 1.49 in stiffness; 1.11 in physical function, and 1.20 in total WOMAC score. Overall, effect size of combination of PRP and HA intra-articular injection is classified as large effect size (&gt; 0.8) in improving outcome of knee OA. A combination of PRP and HA has large synergistic effect size in improving outcome of moderate and severe OA of knee.

AflaB2® and osteoarthritis: a multicentric, observational, post-marketing surveillance study in Indian patients suffering from knee osteoarthritis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis (OA) is one of the most debilitating chronic degenerative joint disorder characterized by pain, inflammation and stiffness of joints with wear and tear of the cartilage. Recent evidences suggest the involvement of the immune pathway in OA development. This study was conducted to evaluate the efficacy and safety of AflaB2&lt;sup&gt;®&lt;/sup&gt; capsules containing Aflapin&lt;sup&gt;®&lt;/sup&gt; and native collagen type II in knee OA patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 40 knee OA subjects were enrolled at the out-patient department (OPD) of three different sites under supervision of physicians as per the inclusion and exclusion criteria of the study. Subjects were instructed to consume AflaB2&lt;sup&gt;® &lt;/sup&gt;capsules once daily orally for three months. They were informed to visit the respective study center as per the schedule visits to assess and record the efficacy and safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; AflaB2&lt;sup&gt;®&lt;/sup&gt; treatment showed significant reduction in pain and stiffness with improvement in physical functions compared to the baseline. The reduction in pain score was observed from 2&lt;sup&gt;nd&lt;/sup&gt; visit on visual analogue scale (VAS). The VAS score was reduced to 1.63±1.23 (p&amp;lt;0.001) from its baseline score 6.0±1.04 at the end of the treatment. The WOMAC Total Score was reduced to 18.1±6.04 (p&amp;lt;0.001) from its baseline score 74.4±8.07 at the end of the treatment. The improvement was observed in WOMAC pain, stiffness and physical functions score. No significant side-effect was reported with AflaB2&lt;sup&gt;®&lt;/sup&gt; treatment throughout the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The present study provides the evidence in support of the potential efficacy and excellent tolerability of oral intake of AflaB2&lt;sup&gt;®&lt;/sup&gt; capsules in reducing OA symptoms.&lt;/p&gt;