Treatment Of Knee Joint Osteoarthritis Research Articles

Pathogenetic and clinical aspects of osteoarthritis and osteoarthritis-associated defects of the cartilage of the knee joint from the standpoint of understanding the role of the subchondral bone

The article presents an analytical review on modern ideas about the osteoarthritis pathogenesis based on the findings regarding the subchondral bone and its importance in the development of this disease. It is shown that the data of numerous studies in recent years reveal more and more evidence demonstrating the primacy of pathological changes in the subchondral bone in the development of osteoarthritis and its progression. The vast majority of scientific papers confirm the fact that hyaline cartilage and subchondral bone tissue are a single morphofunctional biocomposite with an interdependent system of biochemical connections and molecular signaling, as well as correlative reactions to stressful mechanical loads. The authors analyzed in detail the mechanisms of cellular and molecular interaction in the system "hyaline cartilage subchondral bone" in the development of osteoarthritis, vividly demonstrating the active and priority involvement of subchondral bone tissue in the debut and maintenance of the destructive-dystrophic process. The necessity to leave the chondrocentric model of osteoarthritis pathogenesis and the expediency to revise the points of application of therapeutic measures in patients with knee joint osteoarthritis are discussed. The current methods of surgical treatment of knee joint osteoarthritis are critically reviewed from the perspective of their pathogenetic orientation. The authors discuss the relevance in developing the concept of organ-preserving surgery in destructive-dystrophic joint lesions, which should be based on the findings describing the role and significance of subchondral and metaphyseal bone tissue in the above pathologic processes.

Efficacy of Prolotherapy With Periarticular 5% Dextrose In The Treatment of Knee Joint Osteoarthritis

Objective: Determination of the effectiveness of periarticular 5% dextrose prolotherapy in the treatment of knee pain due to osteoarthritis.Material and Methods: The clinical results of prolotherapy with 5% periarticular dextrose in adult female and male patients with knee pain and complaints related to osteoarthritis were evaluated retrospectively. During the examination, we identified the sensitive ligaments in the knee and injected 1 cc of 5% dextrose with a 0.6 * 60 mm sterican needle. In routine practice, stretching exercises are recommended to patients after prolotherapy and for analgesia, a combined analgesic containing paracetemol 500mg + codeine phosphate 10mg + caffeine 30mg is given for the first 3 days. In addition to the initial application, prolotherapy is performed 3 times with an interval of 20 days, and when the Visual Analogue Scale (VAS) score decreases by 80% or more after the first or second injection, prolotherapy is terminated. Results: 30 patients aged between 36-70 years were included in the study. Patients’ mean age was 52,9±9,0 years. Nineteen patients received 3 sessions and 11 patients received 2 sessions of prolotherapy. A significant decrease was achieved in VAS scores of all patients except one patient. The VAS score was 2.9 at the end of the third session meanwhile the initial VAS average was 8.4. None of the patients had any side effects that would terminate the treatment.Conclusion: The data obtained in the study show that prolotherapy with periarticular 5% dextrose is effective in the treatment of knee pain and complaints related to osteoarthritis. However, more comprehensive studies will be guiding the clarification of its place in the osteoarthritis’ treatment.

Treatment of knee joint osteoarthritis in overweight women in outpatient practice

Objectives: evaluation of the clinical efficacy and safety of the healthy joints maintaining compound Artroflex®in knee osteoarthritis (OA) in postmenopausal overweight women in outpatient clinical practice.Patients and methods. An open, prospective observational single-center post-marketing study included 30 postmenopausal women 50–75 years old (mean age 62.3±6.3 years) with knee OA. Patient body mass index (BMI) was >25 (mean body weight 85.3±15.3 kg). Radiographically confirmed primary gonarthrosis stage II according to Kellgren–Lawrence was detected in 26 (87.0%) patients, stage III – in 4 (13.0%). The duration of knee OA ranged from 1 to 21 years (average 7.8±6.1 years).Artroflex®was prescribed 1 capsule 2 times a day for 3 months. During three visits (baseline, after 1 and 3 months), the need for analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) and the occurrence of adverse reactions (AR) were determined. Health status and pain level were also assessed using a visual analogue scale (VAS), the severity of pain and stiffness, limited function according to the WOMAC questionnaire, fatigue/fatigue according to the FACIT scale, the Charlson comorbidity index, satisfaction of the doctor with the results of treatment using the IMOS scale, and satisfaction of the patient with using the IMPSS scale.Results and discussion. A statistically significant decrease in the pain score according to the VAS, an improvement in health status, and the WOMAC index were found in the overwhelming number of patients, regardless of BMI. 90% of women noted decrease in fatigue/fatigue on the FACIT scale, and 93% of patients reported satisfaction with treatment, regardless of the Charlson comorbidity index. The need for NSAIDs after one month of use of the Artroflex®compound decreased by 7%, after 3 months – by 23%. A negative feedback was found between the baseline indicator of health status and the assessment of the effectiveness of therapy. No serious ARs were identified during the study.Conclusion. Feasibility of using the Artroflex®compound in real clinical practice in patients with knee OA and excessive body mass has been shown.

Functional improvement and thickening of quadriceps muscle and femoral intercondylar cartilage after a single intra-articular injection of a new bionic cross-linked hyaluronic acid Flexotron Cross in the treatment of knee joint osteoarthritis

To evaluate an effectiveness of a single intra-articular injection of a new cross-linked hyaluronic acid by measuring thickness of the quadriceps muscle and femoral intercondylar cartilage in addition to subjective assessment. There were 49 patients with gonarthrosis (Kellgren-Lawrence grade II-III) who underwent a single intra-articular injection of Flexotron Cross into the knee joint with higher grade of arthrosis. The scores were assessed at baseline, after 1, 3 and 6 months using: 1) visual analogue scale (VAS) of pain syndrome, 2) Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 3) Lequesne Index, 4) duration of standing on one leg, 5) thigh circumference, 6) thickness of quadriceps muscle and femoral intercondylar cartilage according to ultrasound data. A 6-month follow-up comprised 46 patients. HA administration significantly improved all parameters (p <0.001). VAS and WOMAC pain scores were significantly improved after 1, 3 and 6 months (p <0.01). Thickness of the quadriceps muscle and femoral intercondylar cartilage was increased after 3 and 6 months (p <0.05). Lequesne Index, duration of standing on one leg and thigh circumference were also increased in 6 months after HA administration (p <0.01). Flexotron Cross is effective subjectively and objectively for at least 6 months and safe for the treatment of gonarthrosis.

Comparative study of effectiveness and safety of nonsteroidal anti-inflammatory drugs in patients of knee joint osteoarthritis of knee, tertiary care hospital, Bidar, India

Background: Osteoarthritis (OA) is a joint failure and OA is the most frequent chronic joint disease causing pain and disability. Where all the structures of joints have undergone pathological changes and they are hyaline articular cartilage loss which may be focal or non-uniform, initially it will be focal then spread all over non-uniformly. Non-Steroidal Anti Inflammatory Drugs (NSAID) are the mainstay of medical management of OA. Increased in reports suggests that GIT adverse effect with old NSAID’s and cardiovascular effects with selective cyclooxygenase-2 (COX2) inhibitors had precipitated to chase for better NSAID’s with minimal adverse effects. The current study compares the clinical effectiveness and safety of newer NSAID’s, etoricoxib, lornoxicam, to diclofenac which has been standard therapy in patients of OA of the knee joint.Methods: The current study is randomized, prospective, open-label, parallel group study conducted in 120 patients with OA of the knee joint diagnosed using American College of Rheumatology criteria. After getting the informed consent, they were randomized in three groups of 40 patients each who received tablet etoricoxib 120mg BID, tablet Lornoxicam 16mg BID, tablet diclofenac 50mg TID respectively. The duration of the study is 12 weeks. Data are calculated, tabulated and analyzed using analysis of variance (ANOVA) test, and level of significance was determined by its P value.Results: After 12weeks of treatment, the severity of pain and functional indices using visual analog scale and Western Ontario and McMaster Universities Osteoarthritis score were significantly better (P &lt;0.05) in etoricoxib group as compared to lornoxicam or diclofenac group along with a lesser rate of adverse effects.Conclusions: It is concluded that etoricoxib is more effective and tolerated NSAID than lornoxicam and diclofenac in the treatment of knee joint OA.

Medium and long term results of high tibial osteotomy for the treatment of knee joint osteoarthritis

To analyze the medium and long term results of high tibial osteotomy(HTO) for the treatment of knee joint osteoarthritis(OA). From January 2001 to December 2005, 45 patients(63 knees)with medial compartment OA were treated with HTO, including 10 males (15 knees) and 35 females (48 knees), ranging in age from 45 to 64 years old with an average of (55.76±5.54) years old. Preoperative normal anteroposterior and lateral X ray films of weight bearing knee were conducted, with an accurate measurement of the femoral tibial angle(FTA), and the mass of lateral tibial osteotomy was determined according to the preoperative FTA. Routine HTO was performed after epidural anesthesia. Most patients were treated with middle part fibulae osteotomy, and some patients were treated with the release of proximal tibiofibular joints. The functional exercise no weight bearing ambulation and weight bearing exercise began on the second day after operation 2 weeks after operation and 8 to 10 weeks after operation respectively. All the cases should be examined with X ray postoperatively on the second day, 8 to 10 weeks, 6 months, 1 year after operation and once a year. The VAS, HSS and KSS were used to evaluate knee pain, deformity, function, and range of motion preoperatively, 3 to 5 years postoperatively, 10 to 14 years postoperatively in all the patients. Forty three patients (61 knees) were followed up for more than 10 years. All the incisions were healed at the first stage. The bone healing was achieved 8 to 10 weeks after operation. The knee joint was evaluated according to the HSS standard 10 to 14 years after operation, and the average score was 76.24±5.27. Twenty seven patients got an excellent result, 25 good, 7 fair and 2 poor. The VAS, HSS and KSS scores of postoperative 3 to 5 years and 10 to 14 years were better than those of before operation. There were no obvious differences of scores between postoperative 3 to 5 years and postoperative 10 to 14 years. The long term curative effect of high tibial osteotomy in the treatment of knee OA(medial compartment arthritis) is satisfied, if the indications for surgical treatment are appropriate, and postoperative active exercises are performed.

Various therapies in the treatment of patients with medial compartment osteoarthritis of knee joint: A review of literature

Introduction: knee joint osteoarthritis is one of the most prevalent musculoskeletal problems in adult population, which cause pain and functional limitations. Involvement of medial compartment is almost 10 times more common than lateral compartment, which results in varus deformity among patients with medial compartment osteoarthritis of knee joint. Main objectives in the treatment of knee joint osteoarthritis are reducing pain, improving physical functions and reducing the progress of the disease. Treatments of knee joint osteoarthritis are classified in two categories: operative treatment and conservative treatment. The aim of this study is to investigate the effect of different therapies in the treatment of patients with medial compartment osteoarthritis of knee joint. Methods & Materials: An extensive electronic search was carried out through internationally published scholarly articles in ScienceDirect, Pubmed and Google Scholar from 1973 to 2014. Methodological quality of papers was assessed using Down and Black checklist. Results: With the literature search, we identified 60 papers. 24 articles were acquired in full text on the basis of inclusion criteria for further evaluation. The scores of reporting, external validity, internal validity (bias) and internal validity (confounding) were 2 to 9, 1 to 3, 2 to 5 and 2 to 5 respectively. Conclusion: Among different non-surgical therapies in the treatment of patients with medial compartment osteoarthritis of knee joint, all therapies had reported satisfactory results in reducing pain and disability, but with regard to low number of available literature, more randomized clinical trials are needed so that one can achieve determinable results in this regard. Keywords: Knee joint osteoarthritis, Physiotherapy, Weight loss, knee brace, Lateral wedge insole

Longitudinal changes in knee kinematics and moments following knee arthroplasty: a systematic review.

Knee arthroplasty (KA) is recognized as an effective treatment of knee joint osteoarthritis and up to 90% of patients experience substantial pain relief. There has been no systematic review synthesizing the longitudinal changes in gait following KA. The aims of this systematic review were to determine the effects of KA on (i) frontal plane and (ii) sagittal plane kinematic and kinetic parameters during the stance phase of gait. MEDLINE (PubMed), CINAHL, SPORTdiscus (EBSCO), and Cochrane Library (Wiley) were searched until April 10th, 2014. 1,765 articles were identified, of which 19 studies describing 3-dimensional gait analysis pre- and post-KA were included. Study quality was evaluated by two reviewers independently using the Downs and Black checklist. Following KA, in the frontal plane, the maximum knee adduction angle and external knee adduction moment (KAM) tended to decrease. In the sagittal plane, findings suggest that the maximum knee flexion moment is increased. From the ten studies that included a healthy reference group, it was unclear whether gait variables returned to normal following KA. Overall, it appears that KA results in a decreased peak KAM and maximum knee adduction angles, an increased peak knee flexion moment and inconsistent changes in the peak knee flexion angle. Knowledge gaps remain due to methodological inconsistencies across studies, limited statistical analysis, and largely heterogeneous sample populations. More research is needed to determine whether KA restores gait patterns to normal, or if additional rehabilitation may be needed to optimize gait following surgery for osteoarthritis.

Treatment of knee joint osteoarthritis with Glucosamine: aspects of pharmacokinetics (a literature review)

Knee joint osteoarthrosis is the commonest form of arthrosis. With regard for ageing of population in all countries it is prognosticated that the number of problems, caused by this disease, will significantly increase within the next few decades. As a medicinal drug for treating symptoms and preventing development of knee joint osteoarthrosis the studies involved Glucosamine, which demonstrated its symptomatic and modifying effects. Nevertheless the results of studies of the use of Glucosamine in gonarthrosis, made by today, turned out to be contradictory because of differences and/or shortcomings of models, numbers of observations, inadequacy in the composition of the studied drugs and their quality. The review provides the up-to-date level of information on pharmacokinetics of Glucosamine that may help in interpreting results of pharmacodynamics and clinical efficacy, received in different clinical studies.

Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid

This study aimed to find a simple, cost-effective, and time-efficient method for the preparation of platelet-rich plasma (PRP), so the acquired benefits will be readily available for multiple procedures in smaller outpatient clinics and to explore the safety and efficacy of the application of PRP in the treatment of degenerative lesions of articular cartilage of the knee. The study was designed as a prospective, cohort study with a control group. A total of 120 patients with Grade 1, 2, or 3 osteoarthritis according to the Kellgren and Lawrence grading scale were enrolled in the study. One group of patients was treated using three intra-articular applications of PRP, and the second group of patients was given three injections of hyaluronic acid. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index and the 11-point pain intensity Numeric Rating Scale. On average, a 4.5-fold increase in platelet concentration was obtained in the PRP group. No severe adverse events were observed. Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up. Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis. Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed.

Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid

Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid

The clinical observations and comparion on using the sodium hyaluronate intraarticular injection purely and that combined with Chinese medicine fumigating and washing for 166 case of knee joint ostearthritis

Objective To observe and compare the curative effect of sodium hyaluronate intraarticular injection purely and that combined with Chinese medicine fumigating and washouting therapy for knee joint ostearthritis.Methods 126 cases (206 knees) were divided randomly into two groups.Control group was treated with sodium hyaluronate intraarticular injection,and Experimental group was treated with sodium hyaluranate intraarticular injection combined with Chinese medicine fumigating and washing therapy,then observe and compare the curative effect.Results The disparity of total effective rate between these two groups was significant (P＜0.05).In the aspects of improving ache,tenderness,and chilly limbs,the comparison of these two sets is significant(P＜0.01).In the aspects of improving the swell and funcation of movement,comparison of these two sets is non-significant(P＞0.05),the curative effect was equal.Conclusions The treatment of knee joint osteoarthritis with sodium hyaluronate intraarticul injection combined with Chinese medicine fumigating and washing therapy can effectively alleviate ache,symptnm,etc.And improve function of the joint,raise the sufferer's quality of life.There is obvious advantage in keeping away of reeidivation.It was a kind of safe,effective nonoperative therapeutic alliance method of traditional Chinese and western medicine,which with small poisonous side effect and low relapse rate. Key words: Knee joint osteoarthritis; Sodiam Hyaluronate; Chinese medicine fumigating and washing therapy; Nonoperative therapeutic alliance