Treatment Of Knee Osteoarthritis Patients Research Articles

Current advances of photobiomodulation therapy in treating knee osteoarthritis.

Knee osteoarthritis (KOA) is manifested by low-grade joint inflammation, irreversible cartilage degeneration, subchondral bone remodeling and osteophyte formation. It is one of the most prevalent degenerative diseases in the elderly. KOA usually results in chronic joint pain, physical impairment even disability bringing a huge socioeconomic burden. Unfortunately, there is so far no effective interventions to delay the progression and development of KOA. There is a pressing need for explorations and developments of new effective interventions. Photobiomodulation therapy (PBMT), also known as low-level light therapy (LLLT), has attracted widespread attention in treating KOA because it is drug-free, non-invasive, safe and useful with rarely reported side effects. It provides the biological stimulatory effects primarily by enhancing the activity of mitochondrial cytochrome c oxidase. This stimulation, in turn, fosters cell proliferation and tissue regeneration. In addition to this, the paper provides a concise overview of the light parameters and the effectiveness of PBMT when applied in the treatment of KOA patients in clinical settings. It also delves into the experimental evidence supporting the modulatory effects of PBMT and its potential underlying mechanisms in addressing synovitis, cartilage degeneration, and pain resolution.

Clinical Value of Tranexamic Acid Combined with Total Knee Arthroplasty in the Treatment of Knee Osteoarthritis

This paper aims to explore the clinical value of tranexamic acid combined with total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA). The research period was from March 2020 to December 2022. A total of 50 samples of KOA patients were selected and divided into the study group (n = 25) and the control group (n = 25) by lottery method of medical record envelopes. The patients in the control group were treated with TKA, and the patients in the study group were treated with tranexamic acid combined with TKA. The surgery-related indicators, visual analogue pain score (VAS), inflammatory factor levels, motor function scores, and incidence of complications were compared between the two groups. The intraoperative blood loss in the study group was lower than that in the control group (P < 0.05), and there was no significant difference in postoperative hospital stay between the two groups (P > 0.05). The postoperative VAS scores in the study group were lower than those in the control group (P < 0.05), while the postoperative inflammatory factor levels of the study group were lower than those of the control group (P < 0.05). The postoperative motor function scores of the study group were higher than those of the control group (P < 0.05), and the incidence of complications in the study group was lower than that in the control group (P < 0.05). The treatment of KOA patients with tranexamic acid combined with TKA can reduce intraoperative blood loss, relieve pain, reduce the level of inflammatory factors, improve postoperative motor function, and reduce the incidence of complications, which can be widely applied in clinical practice.

The Evaluation of Cartilage Regeneration Efficacy of Three-Dimensionally Biofabricated Human-Derived Biomaterials on Knee Osteoarthritis: A Single-Arm, Open Label Study in Egypt.

Full thickness cartilage defects in cases of knee osteoarthritis are challenging in nature and are difficult to treat. The implantation of three-dimensional (3D) biofabricated grafts into the defect site can be a promising biological one-stage solution for such lesions that can avoid different disadvantages of the alternative surgical treatment options. In this study, the short-term clinical outcome of a novel surgical technique that uses a 3D bioprinted micronized adipose tissue (MAT) graft for knee cartilage defects is assessed and the degree of incorporation of such graft types is evaluated via arthroscopic and radiological analyses. Ten patients received 3D bioprinted grafts consisting of MAT with an allogenic hyaline cartilage matrix on a mold of polycaprolactone, with or without adjunct high tibial osteotomy, and they were monitored until 12 months postoperatively. Clinical outcomes were examined with patient-reported scoring instruments that consisted of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS). The graft incorporation was assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. At 12 months follow-up, cartilage tissue biopsy samples were taken from patients and underwent histopathological examination. In the results, at final follow-up, the WOMAC and KOOS scores were 22.39 ± 7.7 and 79.16 ± 5.49, respectively. All scores were significantly increased at final follow-up (p < 0.0001). MOCART scores were also improved to a mean of 82.85 ± 11.49, 12 months after operation, and we observed a complete incorporation of the grafts with the surrounding cartilage. Together, this study suggests a novel regeneration technique for the treatment of knee osteoarthritis patients, with less rejection response and better efficacy.

Study on Treatment of Knee Osteoarthritis Patients by Acupoint Application and Fumigation and Washing with Traditional Chinese Medicine

Study on Treatment of Knee Osteoarthritis Patients by Acupoint Application and Fumigation and Washing with Traditional Chinese Medicine

The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis Patients (CLIP-OA) trial: Design and methods

Being overweight or obese is a primary modifiable risk factor that exacerbates disease progression and mobility disability in older knee osteoarthritis (OA) patients. Lifestyle interventions combining exercise with dietary weight loss (EX+DWL) yield meaningful improvements in mobility and weight loss that are superior to EX or DWL alone. Unfortunately, community access to practical, sustainable weight management interventions remains limited and places knee OA patients at increased risk of mobility disability. The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis patients (CLIP-OA), was a two-arm, 18 month randomized-controlled, comparative effectiveness trial designed to contrast the effects of an evidence-based, theory-driven EX+DWL intervention, personalized to patient needs and delivered by our community partners, with those of the Arthritis Foundation's Walk With Ease (WWE) standard of care self-management program in the treatment of knee OA patients with overweight or obesity. The primary outcome of the CLIP-OA trial was mobility performance assessed using the 400-m walk test (400MWT). Secondary outcomes included weight loss, pain, select quality of life and social cognitive variables, and cost-effectiveness of intervention delivery. Findings from the CLIP-OA trial will determine the comparative and cost-effectiveness of the EX+DWL and WWE interventions on key clinical outcomes and has the potential to offer a sustainable medium for intervention delivery that can promote widely accessible weight management among knee OA patients with overweight or obesity. Trial Registration: NCT02835326.

Evaluation of the effectiveness and safety of icariin in the treatment of knee osteoarthritis: A protocol for a systematic review and meta-analysis.

Background:Knee osteoarthritis (KOA) is a chronic degenerative disease involving cartilage and surrounding tissues. It causes a huge burden to social and medical resources and seriously affects people's living and working ability. In recent years, people have become increasingly interested in the application of Chinese medicine monomers to treat KOA. Among them, icariin plays an important role in the clinical treatment of KOA. Therefore, to evaluate the effectiveness and safety of icariin in the treatment of KOA, we conducted this study to provide a new basis for the clinical treatment of KOA.Methods:We propose a systematic search of the PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and China Biomedical databases for all randomized controlled trials examining the use of icariin in the treatment of KOA patients up to October 20, 2021. The screening and data extraction processes will be performed independently by 2 researchers. We will use the Cochrane risk bias assessment tool to evaluate the quality of the studies that met the inclusion criteria. The data will be statistically analyzed using RevMan5.3 software.Result:This study will provide high-quality evidence for the effectiveness and safety of icariin in the treatment of KOA.Conclusion:The purpose of this study was to explore the efficacy of icariin in the treatment of KOA and to provide clinicians and patients with new treatment strategies.INPLASY registration number:INPLASY2021110015.

Нові рекомендації з локальної терапії остеоартрозу колінних суглобів та дослідження ефективності кетопрофену: огляд літератури й результати власних досліджень

Актуальність. Основною скаргою пацієнтів з остеоартрозом (ОА) є біль помірної або значної інтенсивності, а найбільш часто вживаними засобами, що використовують для зменшення больового синдрому, — нестероїдні протизапальні препарати (НПЗП). Мета: вивчення ефективності та безпечності терапії препаратом кетопрофен у формі геля, що використовували для лікування хворих з гонартрозом, а також його впливу на вираженість больового синдрому та якість життя. Матеріали та методи. На базі відділу клінічної фізіології та патології опорно­рухового апарату ДУ «Інститут геронтології ім. Д.Ф. Чеботарьова НАМН України» проведене пілотне дослідження, в якому взяли участь 23 особи чоловічої та жіночої статі віком 50–69 років з остеоартрозом колінних суглобів І–ІІ стадії. Пацієнти були поділені на дві групи: група І — 13 пацієнтів, лікування яких полягало у нанесенні препарату кетопрофен у вигляді аплікацій тонким шаром на колінний суглоб двічі на добу протягом 10 днів, і група ІІ — 10 пацієнтів, які приймали плацебо (вазелінова олія, що не містила у своєму складі кетопрофен та активні допоміжні речовини) у вигляді аплікацій на колінний суглоб двічі на добу протягом 10 днів. Дослідження складалось із скринінгу, візиту через 10 днів терапії та візиту через 20 днів після припинення прийому терапії. При кожному візиті проводили оцінку інтенсивності больового синдрому та функціонального стану колінних суглобів, що визначали за допомогою шкали WOMAC (загальний показник, показники субшкал болю, скутості, повсякденної активності), індексу Лекена та 15­метрового тесту. Крім того, проведено огляд статей електронних медичних баз даних PubMed, Google Scholar та Cochrane Library, у якому надані велика кількість публікацій щодо ефективності різних форм та представників групи НПЗП і їх порівняльний аналіз. Результати. У групі пацієнтів, які приймали препарат кетопрофен, зареєстроване вірогідне зменшення інтенсивності больового синдрому, проявів скутості, поліпшення повсякденної активності за даними субшкал опитувальника WOMAC та зменшення часу виконання 15­метрового тесту. Висновки. Кетопрофен є ефективним та безпечним засобом локальної терапії при лікуванні ОА колінних суглобів.

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.

Early clinical effects of total knee arthroplasty with kinematic alignment assisted by patient-specific instrumentation

Objective: To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI). Methods: The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results: The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° (t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative (t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative (t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) (M(Q(R))) preoperative to 5.5 (5.25) postoperative (Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions: PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.

Effectiveness of physiotherapy management in knee osteoarthritis: A systematic review

Background: Osteoarthritis is a major cause of musculoskeletal disability. Nonpharmacological and nonsurgical treatment is preferred for the management of knee osteoarthritis (OA). However, evidences are lacking regarding the effectiveness of multimodal physiotherapy program including, combination of various physical modalities (TENS, IR, US etc.) with therapeutic exercises, for the management of knee OA. Objectives: To determine recent research evidences for the effectiveness of combination of physical therapy interventions for treatment of knee OA patients. Methods: This systematic review mainly includes randomized controlled trails. Searching done by Google scholar, Pub med and PEDro from 2010 to 2019. We used terms like-knee pain, OA, TENS, exercise, and physiotherapy management. Results: Present outcomes shows that physiotherapy treatment is effective technique in reducing pain in patients with Knee OA without adverse effects. After implementing the inclusion and exclusion criteria, 100 articles were retrieved using the key words, but only 10 articles were selected for the study. Conclusion: Electrotherapy modalities in conjunction with exercise therapy program designed for treating knee OA patients proved to be more superior to exercise alone at improving quadriceps muscle activation by reducing pain and increasing function during exercise.

Duloxetine Combined With Intra-articular Injection of Corticosteroid and Hyaluronic Acid Reduces Pain in the Treatment of Knee Osteoarthritis Patients

Duloxetine Combined With Intra-articular Injection of Corticosteroid and Hyaluronic Acid Reduces Pain in the Treatment of Knee Osteoarthritis Patients

Clinical efficacy of resveratrol as an adjuvant with meloxican in the treatment of knee osteoarthritis patients: A double-blind, randomised, placebo-controlled trial

The present study aimed to evaluate the effect of the adjuvant use of resveratrol with meloxicam on the clinical scores of knee OA patients. This was a double-blind placebo-controlled randomised trial involving 100 patients with knee osteoarthritis performed at the Shar Teaching Hospital, Sulaimani General Hospital and Specialised Rheumatology Center, Sulaimani City from December 2016 to September 2017. The efficacy of the treatment was evaluated by measuring the changes from baseline in the KOOS score, WOMAC index, and VAS-100 score after 90 days of treatment. Resveratrol significantly improves the knee OA pain and associated symptoms compared with placebo, and both clinical scores were found to be eligible for following treatment outcomes. In conclusion, resveratrol, when used in combination with meloxicam, improves pain and symptom scores in patients with mild-to-moderate knee OA compared with placebo. The intervention with a dietary supplement may significantly impact the pain and overall quality of life in patients with knee OA.

Efficacy of pulsed Nd:YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial.

The purpose of this study was to investigate the effects of pulsed Nd:YAG laser plus glucosamine/chondroitin sulfate (GCS) in patients with knee osteoarthritis (KOA) by examining changes in pain and knee function, as well as synovial thickness (ST) and femoral cartilage thickness (FCT). Sixty-seven male patients participated, with a mean (SD) age of 53.85 (4.39) years, weight of 84.01 (4.70) kg, height of 171.51 (3.96) cm, and BMI of 28.56 (1.22). Group 1 was treated with high-intensity laser therapy (HILT), GCS, and exercises (HILT + GCS + EX). Group 2 was treated with GCS plus exercises (GCS + EX), and group 3 received placebo laser plus exercises (PL + EX). The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. ST and FCT were measured by ultrasound examination. Statistical analyses were performed to compare differences between baseline and after 6weeks of treatment and then after 3months of follow-up. Statistical significance was set at p < 0.05. VAS and WOMAC were significantly decreased in all groups after 6weeks, with nonsignificant differences between 6weeks and 3months of follow-up. ST was significantly decreased in the HILT + GCS + EX group posttreatment, with nonsignificant decreases in the GCS + EX and PL + EX groups, as well as nonsignificant differences to FCT in all groups. Overall, pulsed Nd:YAG laser combined with GCS and exercises was more effective than GCS + EX and exercises alone in the treatment of KOA patients.

Observation of the effect of TKA in the treatment of knee osteoarthritis patients with varus deformity

Objective To explore the clinical effect of aritificial total knee arthroplasty （ TKA） in the treat-ment of knee osteoarthritis （ KOA） patients with varus deformity .Methods 41 KOA patients （ 52 knees ） with varus deformity were treated by TKA ,and the clinical effect was observed .Results After treatment ,the knee varus angle , flexion contracture degrees,HSS score were （174.50 ±2.10）°,（0.30 ±0.16）°,（87.60 ±4.70）points,respective-ly,which were significantly improved compared with [（19.80 ±1.30）°,（21.20 ±0.90）°,（37.30 ±3.50）points] before treatment （t=451.68,165.99,69.05,51.57,all P〈0.05）.Conclusion TKA has an ideal efficacy for knee flexion deformity ,accurately cut bone and soft tissue balance correction is the key in turned knee flexion contracture deformity surgery . Key words: Osteoarthritis; knee; Knee prosthesis; aritificial

Effect of eccentric isokinetic strengthening in the rehabilitation of patients with knee osteoarthritis: Isogo, a randomized trial

BackgroundFemorotibial knee osteoarthritis is associated with muscle weakness in the lower limbs, particularly in the quadriceps, which results in disease progression. The interest of having muscular strengthening as part of the therapeutic arsenal for the medical treatment of knee osteoarthritis is now well established.The functional disability induced by knee osteoarthritis manifests itself principally when walking, notably downhill, during which the muscles are called upon to contract eccentrically.We can therefore think that eccentric muscular strengthening could bring a functional benefit that is superior to concentric muscular strengthening.Methods/DesignThis is a prospective, randomized, bicenter, parallel-group, international study. Eighty patients aged from 40 to 75 years old, suffering from medical-stage knee osteoarthritis, will undertake 6 weeks of isokinetic muscular strengthening. Randomization determines the mode of muscular strengthening: either exclusively eccentric or exclusively concentric.The principal objective is to demonstrate the superiority of the improvement in the quadriceps isokinetic torque after isokinetic muscular strengthening by the eccentric mode compared to the concentric mode.The following parameters are also evaluated: the variations in the level of pain, the parameters of walking (maximum speed over 10 and 200 meters, analysis on a computerized Gaitrite™ treadmill), static equilibrium (on a FUSYO™ force platform), and the functional status of the patient using the Western Ontario and MacMaster Universities osteoarthritis index (WOMAC) questionnaire after the strengthening period and at 6 months.DiscussionA better knowledge of the most effective mode of muscular strengthening is needed to optimize the functional benefits to the patients. In case of superiority in terms of efficacy of the eccentric mode, the latter could be given priority in the rehabilitation treatment of knee osteoarthritis patients.Trial registrationClinical trials.gov number: NCT01586130.

Body mass index, pain and function in individuals with knee osteoarthritis.

Background:Obesity is a risk factor for progression of knee osteoarthritis (OA), and high body mass index (BMI) may interfere with treatment effectiveness on pain and function in individuals with knee OA. This study investigated the effects of BMI on pain and function during a four-week exercise programme in patients with knee OA.Materials and Methods:Forty-six (31 women and 15 men) participants with knee OA of different BMI categories (15 normal weight participants, 13 over weight participants and 18 obese participants), received standardised exercise therapy programme twice a week for 4 weeks. Outcome included a 10-point pain rating scale for pain-intensity and the western Ontario and McMaster university osteoarthritis index (WOMAC) for physical function.Results:Two-way repeated measure analysis of variance (ANOVA) on pain assessment score revealed a significant effect of time (F = 1049.401, P < 0.001) and group (F = 9.393, P < 0.001) on pain. Similar significant effect of time (F = 595.744, P < 0.001) and group (F = 5.431, P = 0.008) was obtained for WOMAC score on function. Post hoc analysis revealed significant difference between the normal weight and overweight group (t = 2.472, P = 0.016) and between normal weight and obese group (t = 3.893, P = 0.005) on pain outcome at the 4th week post treatment. No significant difference was found at 4th week post treatment on WOMAC scores (F = 2.010, P = 0.146).Conclusion:Exercise improved pain and function scores in OA patients across the BMI groups. Overweight independent of obesity may interfere with effectiveness of pain control during the symptomatic treatment of knee OA patients.

Efficacy and safety of continuous intra-articular hyaluronic acid injection (Hyalgan®) in treatment of knee osteoarthritis patients who underwent high tibial osteotomy, clinical and MRI evaluation

Efficacy and safety of continuous intra-articular hyaluronic acid injection (Hyalgan®) in treatment of knee osteoarthritis patients who underwent high tibial osteotomy, clinical and MRI evaluation

Effects of obesity on quadriceps dynamic strengthening and isometrics exercise for the treatment of knee osteoarthritis patients

Knee osteoarthritis (KOA) is a major cause of pain and functional impairment among elders. Currently, there are neither feasible preventive intervention strategies nor effective medical remedies for the management of...