Treatment Of Knee Osteoarthritis Research Articles

Efficacy and safety of curcumin therapy for knee osteoarthritis: A Bayesian network meta-analysis

Ethnopharmacological relevanceCurcumin, a polyphenolic compound extracted from turmeric (Curcuma longa L.), is widely used in traditional Chinese medicine to treat osteoarthritis and rheumatoid arthritis. Clinical and experimental studies show that curcuminoid formulations have considerable clinical application value in the treatment of knee osteoarthritis (KOA). Aim of the studyTo evaluate the efficacy and safety of curcumin, both alone and in combination with other drugs, in KOA treatment through a Bayesian network meta-analysis (NMA). MethodsWe searched PubMed, Embase and Cochrane Library for randomized controlled trials of curcumin for KOA treatment. The time range of the search was from the establishment of each database to April 26, 2023. The NMAs of outcome indicators were all performed using a random-effects model. NMAs were calculated and graphed in R using MetaInsight and Stata 140 software. Measurement data were represented by the mean difference (MD), while count data were represented by the odds ratio (OR); the 95% confidence interval (CI) of each effect size was also calculated. ResultsThis study included 23 studies from 7 countries, including 2175 KOA patients and 6 interventions. The NMA results showed that compared with placebo, curcumin significantly reduced the visual analogue scale pain score (MD = −1.63, 95% CI: −2.91 to −0.45) and total WOMAC score (MD = −18.85, 95% CI: −29.53 to −8.76). Compared with placebo, curcumin (OR = 0.17, 95% CI: 0.08 to 0.36), curcumin + NSAIDs (OR = 0.01, 95% CI: 0.00 to 0.13) and NSAIDs (OR = 0.11, 95% CI: 0.02 to 0.47) reduced the use of rescue medication. Compared with NSAIDs, curcumin (OR = 0.51, 95% CI: 0.25 to 0.94) and curcumin + NSAIDs (OR = 0.23, 95% CI: 0.06 to 0.9) had a reduced incidence of adverse reactions. The surface under the cumulative ranking curve results indicated that curcumin monotherapy, curcumin + chondroprotective agents, and curcumin + NSAIDs have good clinical value in KOA treatment. ConclusionsCurcumin, either alone or in combination with other treatments, is considered to have good clinical efficacy and safety in KOA treatment. Drug combinations containing curcumin may have the dual effect of enhancing efficacy and reducing adverse reactions, but this possibility still needs to be confirmed by further clinical and basic research.

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.

Short-term and long-term effectiveness of acupuncture and Tuina on knee osteoarthritis: study protocol for a randomized controlled trial.

The effectiveness of acupuncture and tuina in treating knee osteoarthritis (KOA) is still controversial, which limits their clinical application in practice. This study aims to evaluate the short-term and long-term effectiveness of acupuncture and tuina on KOA. This parallel-group, multicenter randomized clinical trial (RCT) will be conducted at the outpatient clinic of five traditional Chinese medicine hospitals in China. Three hundred and thirty participants with KOA will be randomly assigned to acupuncture, tuina, or home-based exercise group with a ratio of 1:1:1. The primary outcome is the proportion of participants achieving a minimal clinically important improvement defined as a ≥ 12% reduction on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain dimension on short term (week 8) and long term (week 26) compared with baseline. Secondary outcomes are knee joint conditions (pain, function, and stiffness), self-efficacy of arthritis, quality of life, and psychological conditions, which will be evaluated by the WOMAC score and the Patient Global Assessment (PGA), and in addition, the respondents index of OMERACT-OARSI, Short Form 12 Health Survey (SF-12), arthritis self-efficacy scale, and European five-dimensional health scale (EQ-5D). Adverse events will be collected by self-reported questionnaires predefined. https://www.chictr.org.cn.

New concept of orthosis treatment for knee osteoarthritis: Clinical and radiological outcomes.

Given the increasing numbers of young patients with knee osteoarthritis there is a need for treatments that can postpone a joint prosthesis (total knee replacement). As an alternative to the effective yet invasive knee joint distraction procedure, a knee orthosis was developed aiming to unload the affected knee and improving synovial fluid flow. The aim of this study was to examine the effectiveness of using a load-reducing orthosis for two months on functioning, pain, and disease progression (e.g. amount of damaged cartilage) in patients with symptomatic osteoarthritis of the knee for at least one year. This is an interventional single-center pilot study. Ten patients with symptomatic osteoarthritis of one knee (5males/5 females; median age 57; age range 42-59) used a custom-made orthosis for 60 days during daily life activities that involved knee loading (e.g. standing, walking, but not during stair climbing). Cycling was not allowed. Clinical outcomes were assessed up to 24 months after intervention at 6 timepoints using patient reported-outcome measures Western Ontario and McMaster Universities Osteoarthritis (WOMAC) range 0-100; Visual Analogue Scale (VAS), range 0-100 for pain. Minimum joint space width (mJSW) was assessed using knee images digital analysis (KIDA) and articular cartilage volume with magnetic resonance imaging (MRI) using custom software at baseline and at 12 and 24 months follow-up. Clinically beneficial effects were found for functioning (WOMAC improvement compared to baseline ranged between 18 points at 3 months follow-up and 31 points at 12 months follow-up, with only the 24-months follow-up (improvement of 27 points) not reaching statistical significance (p< 0.05)) and for pain (VAS improvement compared to baseline at follow-up time points ranged between 41-56 points; all p< 0.05). No improvements in mJSW- or MRI-derived parameters were found. This study demonstrates that use of a custom-made knee-unloading orthosis for 60 days can result in improved functional ability and decrease in pain in relatively young patients with knee osteoarthritis. No effect on disease progression could be evidenced.

Effect of adding hip exercises to general rehabilitation treatment of knee osteoarthritis on patients’ physical functions: a randomized clinical trial

BackgroundHip adductor and abductor strength were both reduced in KOA patients. But to date, most of the researches have only focused on quadriceps combined with hip abductor strengthening versus quadriceps strengthening.ObjectiveThe aim of the study is to evaluate the effect of adding hip abductor and adductor strengthening to quadriceps strengthening on lower limb strength, knee pain and physical function in patients with medial compartmental knee osteoarthritis.MethodsIn this study, 42 participants, were randomly divided into two groups: the general treatment group (GT group) and the added-hip-exercise group (AH group). All participants were given a general rehabilitation treatment. The AH group performed hip abductor and adductor strengthening in addition to the general rehabilitation treatment. Knee and hip muscle strength, Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go Test (TUGT), Numerical Rating Scale (NRS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed at baseline and 6 weeks. A two-sided 2-sample unpaired t test was performed to compare the difference in mean change scores between AH and GT groups.ResultsFinally, 36 participants completed the study: both groups consist of 18 participants. In the per-protocol analysis, the AH group had a greater improvement in knee extension strength (mean changes, 7.84 versus 36.48; P < 0.001) and hip abduction strength (mean changes, 5.05 versus 26.62; P = 0.001) than the control group. Similarly, the AH group had a greater improvement in the FTSST time (mean changes, 0.40 s versus 3.57 s; P < 0.001) and the TUFT time (mean changes, 0.18 s versus 1.67 s; P = 0.002) than the GH group. No statistical difference was found in the change of WOMAC pain scores and NRS between the 2 groups.ConclusionsOlder adults with knee OA in the AH group had superior muscle strength, symptoms and daily activity performance at the 6th week than those in the GT group. And adding hip exercises could expedite improvement of pain at the 2th week, but not at the 6th week.Trial registrationClinical trial registration numbers and date of registration: ChiCTR-IOR-16009124, Registered 30 August 2016.

Effect of mesenchymal stromal cells transplantation on the outcomes of patients with knee osteoarthritis: A systematic review and meta-analysis.

Cell therapy has been explored as a new regenerative treatment for osteoarthritis in the field of regenerative medicine. However, the efficacy of stem cell transplantation from different sources for the treatment of knee osteoarthritis (KOA) remains controversial. This study integrates and evaluates the previously published data of stem cell transplantation for KOA to explore the curative effect of different stem cells. We conducted a meta-analysis of randomized controlled trials on stem cell therapy for KOA. Measures of efficacy included Visual Analog Scale (VAS), Lequesne index, Lysholm Knee Scoring Scale (LKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Joint injury was evaluated through the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. We analyzed 16 studies involving 875 KOA patients. The stem cell treatment showed significant VAS reduction from the third month onwards. Subgroup analysis suggested the most significant pain relief at different postoperative months came from adipose-derived and umbilical cord-derived stem cells. Autologous adipose tissue resulted in better pain alleviation compared with allogenic. However, autologous bone marrow stem cells did not show increased pain relief over allogeneic ones. Combination therapy (HA and/or PRP) showed no effect. Autologous adipose-derived stem cells demonstrate the most effective recovery of knee joint function. In WORMS assessment, there was no significant difference between the stem cell group and control. Stem cell transplantation proved safe and effective for KOA treatment. Different sources stem cells have a good effect on alleviating knee joint pain, restoring knee joint function, and minimizing patient trauma.

An Analysis of the Treatment of Knee Osteoarthritis with Three-Dimensional Model

Knee osteoarthritis (KOA) is a common degenerative bone and joint disease. Its pathogenesis is based on the deficiency of liver, spleen and kidney, and marked by exogenous wind-cold dampness. According to the pathogenesis and overall concept, Professor Li Zhibin has created a three-dimensional model for the treatment of knee osteoarthritis, that is, the organic combination of internal Chinese medicine, external hot compress and exercise therapy. This article will explore Professor Li Zhibin's treatment of knee osteoarthritis with "three-dimensional model" theory, in order to provide a new direction for the treatment of knee osteoarthritis in the future.

Efficacy and safety of platelet-rich plasma combined with Tai Chi for knee osteoarthritis: study protocol for a placebo-controlled randomized trial

BackgroundNo definitive treatment methods of curative for knee osteoarthritis (KOA). The combined therapies that into account both the biochemical and biomechanical may provide potential opportunities for treat KOA, and previous studies have demonstrated that the platelet-rich plasma of intra-articular injection (IAI-PRP) and exercise treatments afford more benefits than do their corresponding monotherapies. The absence of a specific exercise plan and detailed explanation renders the aforementioned study results questionable. Furthermore, Tai Chi (TC) with moderate-intensity, whole body movements and good adherence may prove to be more effective for treating KOA. However, few studies examined the effectiveness and safety of combined IAI-PRP and TC for KOA.MethodsThis study protocol will be a placebo-controlled, assessor-blinded randomized trial involving 12-week intervention and 1-year follow-up. The stratified randomization will be used to randomly assign the 212 participants to four groups: group A (placebo IAI); group B (PRP IAI); group C (TC and placebo IAI); group D (TC and PRP IAI). Injection will be performed once a week, three consecutive times as a course, after a week of rest to continue the next course, a total of 3 courses (12 week). Additionally, the TC interventions will be carried out 3 days per week for a total of 12 weeks. The primary outcome measures will include the efficacy (Western Ontario and McMaster Universities Osteoarthritis Index), acceptability and safety of these interventions. The secondary outcome measures will include physical function (Timed Up and Go test), walking function (Gait Analysis), inflammatory factor levels (e.g., Interleukin-1 β, interleukin-6, vascular endothelial growth factor), quality of life (36-Item Short Form Health Survey), volume of patellofemoral cartilage and effusion-synovitis (MRI). Two-way of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures.DiscussionThis trial will be first one to propose an integrated scheme combing IAI-PRP and TC for treatment of KOA, based on the consideration of the biochemical and biomechanical pathogenesis of KOA. These results of the study will provide evidence with high quality for integrated IAI-PRP and TC to treatment KOA.Trial Registration Chinese Clinical Trial Registry ChiCTR2300067559. Registered on 11 January 2023.

A bibliometric analysis of intra-articular injection therapy for knee osteoarthritis from 2012 to 2022.

Knee osteoarthritis (KOA) is the most common joint disease worldwide and, with the progression of an aging population, is one of the most important causes of disability worldwide. Its main symptoms include articular cartilage damage, periarticular pain, swelling, and stiffness. Intra-articular (IA) injections offer many advantages over systemic administration and surgical treatment, including direct action on the target joint to improve local bioavailability, reduce systemic toxicity, and lower costs. This study analyzed KOA intra-articular injection treatment and its hot literature and research horizons using bibliometric methodologies and graphical tools to aid future research. We performed a bibliometric analysis of 2360 publications in the Web of Science core collection using CiteSpace software. The United States (28.26% of publications) and China (18%) had the biggest publications. Rush University was the most active institution, but Boston University had the greatest citation/publication rate (65.77), suggesting a high literature standard. The majority of publications were in Osteoarthritis and cartilage. Bannuru RR was the most referenced author, while Filardo, Giuseppe was the most productive author. Studies in platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and microsphere formulation are likely to be future research hotspots. The current scientometric study provides an overview of KOA intra-articular injection therapy studies from 2012 to 2022. This study outlines the current research hotspots and potential future research hotspots in the field of intra-articular injection treatment for KOA and may serve as a resource for researchers interested in this topic.

From sceptic to believer: Acceptability of cognitive muscular therapyTM , a new intervention for knee osteoarthritis.

Cognitive Muscular TherapyTM (CMT) is an integrated behavioural intervention developed for knee osteoarthritis. CMT teaches patients to reconceptualise the condition, integrates muscle biofeedback and aims to reduce muscle overactivity, both in response to pain and during daily activities. This nested qualitative study explored patient and physiotherapist perspectives and experiences of CMT. Five physiotherapists were trained to follow a well-defined protocol and then delivered CMT to at least two patients with knee osteoarthritis. Each patient received seven individual clinical sessions and was provided with access to online learning materials incorporating animated videos. Semi-structured interviews took place after delivery/completion of the intervention and data were analysed at the patient and physiotherapist level. Five physiotherapists and five patients were interviewed. All described a process of changing beliefs throughout their engagement with CMT. A framework with three phases was developed to organise the data according to how osteoarthritis was conceptualised and how this changed throughout their interactions with CMT. Firstly, was an identification of pain beliefs to be challenged and recognition of how current beliefs can misalign with daily experiences. Secondly was a process of challenging and changing beliefs, validated through new experiences. Finally, there was an embedding of changed beliefs into self-management to continue with activities. This study identified a range of psychological changes which occur during exposure to CMT. These changes enabled patients to reconceptualise their condition, develop a new understanding of their body, understand psychological processes, and make sense of their knee pain.

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.

Resistance to enzymatic degradation and efficacy evaluation of crosslinked hyaluronic acid based commercial viscosupplements for knee osteoarthritis treatment

A significant number of people worldwide suffers from knee osteoarthritis (KOA), a chronic and painful disease that is linked to aging, traumatological events and sports medicine. Clinical research indicates that KOA exhibit an altered synovial fluid (SF) with lower endogenous hyaluronic acid (HA) concentration and viscoelastic properties. Nowadays, viscosupplementation by intra-articular HA injections is the most common treatment to restore endogenous HA performance in osteoarthritic SF. In this work, TrHCROSS®, Durolane®, Regenflex®Bio-plus and Monovisc® commercial crosslinked HA viscosupplements were compared in vitro against enzymatic degradation. As key research point, TrHCROSS® demonstrated a considerably increased enzymatic stability compared to the rest of examined viscosupplements, which highlights TrHCROSS® prolonged residence time in joint space reducing more durably and effectively osteoarthritic knee pain. Subsequently, an in-depth physicochemical characterization was realized to support efficacy and stability results of viscosupplements. All in all, TrHCROSS®, developed by SARE® technology, was found to be more successful in treating more durably and effectively KOA based on the remarkable outcomes of conducted trials, which were appropriate findings for the current research investigation.

Prospective Observational Study of a Non-Arthroscopic Autologous Cartilage Micrografting Technology for Knee Osteoarthritis.

Autologous micrografting technology (AMT®) involves the use of autologous micrografts to stimulate/enhance the repair of damaged tissue. This study assessed the efficacy and safety of the AMT® procedure in patients with early stages of knee osteoarthritis. Briefly, the AMT® procedure involved extraction of auricular cartilage, disaggregation using the Rigeneracons® SRT in 4.0 mL of saline solution, and injection of the disaggregated micrografts into the external femorotibial compartment area of the affected knee. Ten patients (4 men, 6 women; age range: 37-84 years) were included in the study. In all patients, there was a steady improvement in knee instability, pain, swelling, mechanical locking, stair climbing, and squatting at 1- and 6-months post-procedure. Improvement in mobility was observed as early as 3 weeks post-procedure in 2 patients. Significant improvements were seen in mean scores of all five subscales of Knee Injury and Osteoarthritis Outcome Score (KOOS [KOOS symptoms, KOOS pain, KOOS ADL, KOOS sport and recreation, and KOOS quality-of-life]) between pre-procedure and 1- and 6-months post-procedure (all p ≤ 0.05). Autologous auricular cartilage micrografts obtained by AMT® procedure (using Rigenera® technology) is an effective and safe protocol in the treatment of early stage knee osteoarthritis. These encouraging findings need to be validated in a larger patient population and in a randomized clinical trial (RCT).

Causal relationships between pain, medical treatments, and knee osteoarthritis: A graphical causal model to guide analyses

ObjectiveRandomized controlled trials (RCTs) are a gold standard for estimating the benefits of clinical interventions, but their decision-making utility can be limited by relatively short follow-up time. Longer-term follow-up of RCT participants is essential to support treatment decisions. However, as time from randomization accrues, loss to follow-up and competing events can introduce biases and require covariate adjustment even for intention-to-treat effects. We describe a process for synthesizing expert knowledge and apply this to long-term follow-up of an RCT of treatments for meniscal tears in patients with knee osteoarthritis (OA). MethodsWe identified 2 post-randomization events likely to impact accurate assessment of pain outcomes beyond 5 years in trial participants: loss to follow-up and total knee replacement (TKR). We conducted literature searches for covariates related to pain and TKR in individuals with knee OA and combined these with expert input. We synthesized the evidence into graphical models. ResultsWe identified 94 potential covariates potentially related to pain and/or TKR among individuals with knee OA. Of these, 46 were identified in the literature review and 48 by expert panelists. We determined that adjustment for 50 covariates may be required to estimate the long-term effects of knee OA treatments on pain. ConclusionWe present a process for combining literature reviews with expert input to synthesize existing knowledge and improve covariate selection. We apply this process to the long-term follow-up of a randomized trial and show that expert input provides additional information not obtainable from literature reviews alone.

Effectiveness of neuromuscular electrical stimulation training combined with exercise on patient-reported outcomes measures in people with knee osteoarthritis: A systematic review and meta-analysis.

This study examined the effectiveness of neuromuscular electrical stimulation (NMES) added to the exercise or superimposed on voluntary contractions on patient-reported outcomes measures (PROMs) in people with knee osteoarthritis (OA). This systematic review was described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) were obtained from a systematic literature search in five electronic databases (PubMed, PEDro, LILACS, EMBASE, and SPORTDiscus) in April 2022. We described the effects of intervention according to each PROMs (scores for Pain; Self-reported functional ability; Symptoms (hear clicking, swelling, catching, restricted range of motion, and stiffness); Daily living function; Sports function; and Quality of life) and used a random-effect model to examine the impact of NMES plus exercise on pain compared with exercise in people with knee OA. Six RCTs (n=367) were included. In the qualitative synthesis, the systematic literature analysis showed improvement in pain after NMES plus exercise compared with exercise alone in three studies. The other three studies revealed no difference between groups in pain, although similar improvement after treatments. In the meta-analysis, NMES at a specific joint angle combined with exercise was not superior to exercise alone in pain management (standardized mean difference=-0.33, 95% CI=-1.05 to 0.39, p=0.37). There was no additional effect of NMES on exercise on self-reported functional ability, stiffness, and physical function compared with exercise alone. In only one study, symptoms, activities of daily living, sports function, and quality of life improved after whole-body electrostimulation combined with exercise. This review found insufficient evidence for the effectiveness of NMES combined with exercise in treating knee OA considering PROMs. While pain relief was observed in some studies, more high-quality clinical trials are needed to support the use of NMES added to the exercise in clinical practice. Electrical stimulation in a whole-body configuration combined with exercise shows promise as an alternative treatment option.

A novel in-situ synthesized bioactive TaZrTi alloy by high energy laser beam for total knee arthroplasty application

Total knee arthroplasty is the gold standard treatment for end-stage knee osteoarthritis, which could significantly improve function and relieve pain for patients. However, the present materials and manufacturing approaches are dissatisfactory for knee implants. In the present work, a Ta60-Zr20-Ti20 (in wt%) coating was in-situ synthesized onto Ti6Al4V alloy via a high energy laser beam. The microstructure analysis indicated that α-Ta/ZrTi solid solution generated into body-centered cubic (bcc) grains in dimensions of several to hundred micrometers. The Ta-riched dendrites nucleated, grew, and expanded in the ZrTi matrix. The mechanical and biological properties of the in-situ synthesized TaZrTi sample are compared with the conventionally rolled Ti6Al4V, which is also the substrate alloy. The mean values of hardness and elastic modulus of in-situ synthesized TaZrTi tested by the nanoindenter, are 10.31 and 134.84 GPa, respectively. These results are harder than the Ti6Al4V counterpart (5.14 GPa) with a preferred slightly low elastic modulus (152.95 GPa of Ti6Al4V). Subsequently, the in-situ synthesized TaZrTi exhibits an excellent wear resistance demonstrated by nano-scratch experiments. In addition, the osteoblastic and endothelial cells were cultured in vitro to evaluate the biocompatibility of in-situ synthesized TaZrTi. The results show a comparable bioactivity and surface affinity compared with the rolled Ti6Al4V in 7 days. Briefly, this in-situ synthesized TaZrTi alloy is expected to shed light on load-bearing orthopedic applications to relieve the pain of patients, and the findings in this study provide an insightful understanding of laser additive manufactured TaZrTi alloy.

Effects of high-power pain threshold ultrasound technique in patients with knee osteoarthritis: A single-blind randomized controlled trial

Osteoarthritis (OA) is a highly prevalent, degenerative disease of the joints manifested by joint pain, tenderness, decreased function, and limited range of motion (ROM). The current study aimed at evaluating the therapeutic effect of the high-power pain-threshold ultrasound technique (HPPTUS) in comparison with conventional ultrasound (US) techniques in patients with knee osteoarthritis (KOA). A single-masked, pre–post randomized controlled trial was conducted. Fifty participants of both sexes (between 40 and 50 years of age), diagnosed with stage II knee osteoarthritis, participated in this study. They were randomized into two groups: Group A (experimental group, n=25), which received HPPTUS on the knee joint in addition to the traditional treatment (hot packs and isometric exercise for quadriceps), and Group B (control group, n=25), which received conventional ultrasound on knee joint in addition to the traditional treatment (hot packs and isometric exercise for quadriceps). Both groups underwent a four-week treatment plan in which sessions were conducted twice per week. The visual analogue scale (VAS) was used to estimate the intensity of pain, Digital Electronic Pressure Algometer was used to measure pressure pain threshold (PPT) on trigger point around knee, and Digital goniometer was utilized to assess ROM of the knee joint before and after treatment. The MANOVA test revealed statistically significant improvements in all variables (VAS, PPT, knee ROM) post-treatment compared to pre-treatment values in the HPPTUS group (experimental group) (p &lt; 0.05), while the control group revealed statistically significant improvement only in VAS post-treatment compared with pre-treatment (p &lt; 0.05). Comparison between groups revealed statistically significant improvements in VAS, PPT, knee ROM in participants receiving HPPTUS compared with the control group (p &lt; 0.05). High-power ultrasound can be effectively implemented in the treatment of knee OA as it produces significant improvements in the intensity of pain, pressure-pain threshold, and knee joint ROM.

The Immediate Impact of Total Knee Arthroplasty Removal From the Medicare Inpatient-Only List on Patient Derived Functional Outcomes and Hospital Satisfaction

BackgroundTotal knee arthroplasty (TKA) is the standard of treatment for end-stage knee osteoarthritis. On January 1, 2018, the Centers for Medicare and Medicaid (CMS) officially removed TKA from their inpatient-only list. The clinical impact of this change is not fully understood yet. MethodsElectronic records were retrospectively reviewed for patients who underwent TKA between January 1 to June 30, 2017, or January 1 to June 30, 2018. Patients completed Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement surveys which assessed patient reported outcomes prior to and following TKA. Hospital statistics for the 2 time points were determined and compared. This was a single institution study resulting in 351 patients in the pre-CMS change group and 350 patients in the post-CMS change group. ResultsAnalysis of the pre-CMS and post-CMS transition cohorts indicated no significant difference in activities of daily living (ADLs), pain, or pain catastrophizing scale preoperatively or 12-months postoperatively. Additionally, there was no difference in the median change between preoperative and postoperative ADL scores (P = .866), yet pain scores approached significance with a P value of .054. The pre-CMS transition group stayed significantly longer in the hospital postoperatively and was more commonly discharged to a skilled nursing facility. No difference was seen in 30-day readmission rates (P = .253). ConclusionsResults showed that patients had similar scores for ADL, quality of life, pain, and pain catastrophizing 12-months following their TKA. Movement of TKA from the Medicare inpatient only list did not have an immediate negative impact for patient reported outcomes and 30-day readmissions at our institution in the 6-month transition period.

WITHDRAWN: Comparison of the application value of 3D printed osteotomy guide plate and artificial intelligence 3D surgical planning in artificial total knee arthroplasty

In this study, we aimed to assess the impact of personalized 3D printing osteotomy guide plates and artificial intelligence (AI) three-dimensional surgical planning in total knee arthroplasty (TKA) for knee osteoarthritis. The clinical data of 60 knee osteoarthritis patients were collected, with 30 undergoing personalized 3D printing osteotomy guide plate-assisted TKA (3D-TKA) and 30 undergoing AI 3D surgical planning-assisted TKA (AI-TKA). Surgical outcomes were comprehensively evaluated, including operation time, intraoperative blood loss, postoperative drainage, hospitalization duration, surgical angles (HKA, FTC, FFC), pain scores (VAS), and Hospital for Special Surgery Scores (HSS).Significant differences emerged between the two groups, favoring the 3D-TKA approach. Notably, the 3D-TKA group exhibited a shorter operation time (81.4±8.9 min vs. 72.9±10.0 min), reduced intraoperative blood loss (160.1±24.3 ml vs. 174.7±25.7 ml), lower postoperative drainage (199.5±29.6 ml vs. 223.8±29.2 ml), and a shorter hospital stay (7.7±1.3 d vs. 6.8±1.6 d) (P<0.05). In the immediate postoperative period, the 3D-TKA group demonstrated significantly lower VAS scores (5.4±0.6 vs. 6.2±1.2) (P<0.05). However, there were no significant differences in measured angle deviations, pain scores, and HSS scores at various time points between the groups (P>0.05).Collectively, both 3D-TKA and AI-TKA approaches yielded improved surgical outcomes and precision for treating knee osteoarthritis. While AI-TKA demonstrated advantages in terms of operation time and hospitalization duration, the 3D-TKA approach proved superior in reducing perioperative blood loss and early postoperative pain. These findings underscore the potential of advanced technological interventions to optimize surgical efficacy and patient outcomes in total knee arthroplasty.

Network meta-analysis of 7 acupuncture therapies for knee osteoarthritis.

With the progression of society aging demographic, the prevalence of knee osteoarthritis (KOA) continues to rise steadily, exerting a significant impact on individuals' quality of life. Acupuncture therapy has garnered extensive utilization in the management of osteoarthritis; however, a comprehensive systematic review integrating acupuncture with traditional Chinese medicine remains absent. This study compared the clinical efficacy of 7 acupuncture methods (electroacupuncture, conventional acupuncture, warm needle, floating needle, fire needle, needle knife, and silver needle) for the treatment of KOA through a network meta-analysis. This study examined the databases-PubMed, EMbase, The Cochrane Library, the China Biology Medicine, Chinese Journal Full-text Database, Wanfang Database, and VIP Database-for randomized controlled trials of the 7 methods for KOA treatment. The search time spanned from the database establishment to March 5, 2022. The primary outcome indicator was the total effective rate, and the secondary outcome indicator was the visual analog scale. After the layer-by-layer screening, the quality of the literature was assessed using the Cochrane systematic reviewer manual 5.1.0 bias risk assessment tool for randomized controlled trials. After data extraction, the R4.0.1 software was used for network meta-analysis. Based on the network meta-analysis, the ranking of interventions based on the surface under the cumulative ranking curve for the total effective rate is as follows: silver needle (0.99) > floating needle (0.97) > needle knife (0.66) > fire needle (0.56) > warm needle (0.44) > conventional acupuncture (0.35) > electroacupuncture (0.13). Regarding the improvement in visual analog scale scores, the surface under the cumulative ranking curve ranking is as follows: silver needle (0.97) > conventional acupuncture (0.67) > needle knife (0.64) > floating needle (0.51) > warm needle (0.44) > fire needle (0.14) > electroacupuncture (0.09). Based on the network meta-analysis, silver needle therapy emerged as the most efficacious and analgesic intervention for KOA. Nevertheless, given the notable variations in the quality and quantity of studies encompassing diverse treatment modalities, the findings of this research necessitate further substantiation through forthcoming high-quality multicenter, large-sample, randomized double-blind trials.