Treatment Of Primary Knee Osteoarthritis Research Articles

Bone Marrow Aspirate Concentrate for Treatment of Primary Knee Osteoarthritis: A Prospective, Single-Center, Non-randomized Study with 2-Year Follow-Up

Bone Marrow Aspirate Concentrate for Treatment of Primary Knee Osteoarthritis: A Prospective, Single-Center, Non-randomized Study with 2-Year Follow-Up

Surgical knee denervation for the treatment of pain due to primary osteoarthritis.

Denervation techniques have increased in popularity for treatment of primary knee osteoarthritis. However, few clinical trials have been conducted on surgical knee denervation. This study was conducted to evaluate the safety and efficacy of a surgical denervation technique for the treatment of primary knee osteoarthritis. Patients were included in the trial if they had failed conservative management for osteoarthritis with corticosteroid injections and were not candidates for total knee arthroplasty. Patients were treated with a surgical knee denervation. Pre- and post-operative scores were assessed to examine the improvement in pain, function, and quality of life. Twenty-four knee denervation procedures were performed in twenty-one patients. The average follow-up time was 21 months, with a minimum follow up of 12 months. Patients experienced an improvement in pain with a decrease in VAS pain scores from 8.7 to 2.9, an improvement in function with a decrease in WOMAC scores from 69 to 32, and an improvement in quality of life with an increase in EQ-5D from 0.183 to 0.646. A clinically significant improvement in pain occurred in 92% patients, while 75% of patients had an improvement in function, and 83% an improvement in quality of life. The treatment of recalcitrant knee pain in non-arthroplasty candidates is a difficult issue. This trial suggests that a surgical denervation technique provides improvement in pain, function, and quality of life. Surgical denervation may be a beneficial treatment for patients with recalcitrant pain from primary knee osteoarthritis.

Proteomic and N-glycoproteomic analyses of total subchondral bone protein in patients with primary knee osteoarthritis

N-glycosylation is an important post-translational modification necessary to maintain the structural and functional properties of proteins. Impaired N-glycosylation has been observed in several diseases. It is significantly modified by the state of cells and is used as a diagnostic or prognostic indicator for multiple human diseases, including cancer and osteoarthritis (OA). Aim of the study was to explore the N-glycosylation levels of subchondral bone proteins in patients with primary knee OA (KOA) and screen for potential biological markers for the diagnosis and treatment of primary KOA. A comparative analysis of total protein N-glycosylation under the cartilage was performed in medial subchondral bone (MSB, N = 5) and lateral subchondral bone (LSB, N = 5) specimens from female patients with primary KOA. To analyse the N-glycosylation sites of the proteins, non-labelled quantitative proteomic and N-glycoproteomic analyses were performed based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) data. Parallel reaction monitoring (PRM) validation experiments were carried out on differential N-glycosylation sites of proteins in selected specimens, including MSB (N = 5) and LSB (N = 5), from patients with primary KOA. In total, 1149 proteins with 1369 unique N-chain glycopeptides were detected, and 1215 N-glycosylation sites were found, in which ptmRS scores for 1163 N-glycosylation sites were ≥ 0.9. In addition, N-glycosylation of the total protein in MSB compared to that in LSB was identified, in which 295 N-glycosylation sites were significantly different, including 75 upregulated and 220 downregulated N-glycosylation sites in MSB samples. Importantly, Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment analyses of proteins with differential N-glycosylation sites showed that they were primarily associated with metabolic pathways including ECM-receptor interactions, focal adhesion, protein digestion and absorption, amoebiasis, and complement and coagulation cascades. Finally, PRM experiments confirmed the N-glycosylation sites of collagen type VI, alpha 3 (COL6A3, VAVVQHAPSESVDN[+3]ASMPPVK), aggrecan core protein (ACAN, FTFQEAAN[+3]EC[+57]R, TVYVHAN[+3]QTGYPDPSSR), laminin subunit gamma-1 (LAMC1, IPAIN[+3]QTITEANEK), matrix-remodelling-associated protein 5 (MXRA5, ITLHEN[+3]R), cDNA, FLJ92775, highly similar to Homo sapiens melanoma cell adhesion molecule (MCAM), mRNA(B2R642, C[+57]VASVPSIPGLN[+3]R), and aminopeptidase fragment (Q59E93, AEFN[+3]ITLIHPK) in the array data of the top 20 N-glycosylation sites. These abnormal N-glycosylation patterns provide reliable insights for the development of diagnostic and therapeutic methods for primary KOA.

Investigate the situation of knee osteoarthristic and evaluate the results of treatment in Ha Dong general hospital in 2021

Objective: To investigate the situation of knee osteoarthritis and evaluate the results of treatment of primary knee osteoarthritis at Ha Dong General Hospital in 2021.Subjects and methods: A retrospective descriptive study on 93 medical records with a diagnosis of knee osteoarthritis according to the standards of the American College of Rheumatology ACR 1991, VAS scale < 6 points, and Damp-Cold combined with Liver and Kidney deficiency according to TCM at Ha Dong General Hospital in 2021. Experimental group: Moxibustion-infrared lamp + Doc hoat ky sinh thang decoction + Electro- acupuncture for 20 days. Control group: Doc hoat ky sinh thang decoction + Electro-acupuncture for 20 days.Results: Physical workers and BMI ≥ 23 increase the risk of knee osteoarthritis. X-ray characteristics of the knee joint: mainly degeneration with 92.47% and inflammation with 60.81%. Features of knee joint ultrasound: Knee effusion accounted for 37.84%, Baker cyst accounted for 11.86%; 83.87% had osteophyte, 51.61% had endplate sclerosis and 39.78% had joint space narrowing. According to modern medicine: the number of patients with knee osteoarthritis and inflamed knee osteoarthritis has a similar incidence. According to traditional medicine: 81.72% were diagnosed with Damp-Cold combined with Liver and Kidney deficiency; 18.28% were Damp-Heat combined with Liver and Kidney deficiency, 9.68% were Damp-Cold standalone. The pain reduction efficiency according to VAS of the experimental group was 5.96 ± 1.09 points, higher than that of the control group which was 4.56 ± 0.77 points with statistical significance (p<0.05). In the experimental group, 30% of patients had no pain, 70% of patients had mild pain. In the control group, 10% of patients had moderate pain, 86.7% had mild pain and only 3.3% of patients had no pain. The difference between the two groups was statistically significant (p<0.05). The improvement effect of the experimental group was better than the control group, the difference was statistically significant (p < 0.05). During 20 days of treatment, there were no unwanted clinical effects.

Comparative Effectiveness of Channa sriatus Extract Versus Glucosamine Sulphate for the Treatment of Primary Knee Osteoarthritis: A Randomised Controlled Trial

Channa striatus, an indigenous freshwater fish, has been shown to treat knee osteoarthritis, but no study has been done to compare its effectiveness with other oral therapy. This study aimed to compare the effectiveness of oral Channa striatus extract and glucosamine sulphate in knee osteoarthritis symptoms and physical function. This is a double-blind randomised controlled trial, conducted among 78 patients with primary knee osteoarthritis. Patients were assigned to receive either 500 mg/d of Channa striatus or 1,500 mg/d of glucosamine sulphate for 6 months. The main outcome measures were pain, stiffness and physical function, as assessed by the Western Ontario and Mc Master Osteoarthritis Index (WOMAC) at baseline, 3- and 6-months post-randomisation. Seventy-three patients completed the study (Channa striatus, n = 37; glucosamine sulphate, n = 37). There was no significant between-group difference in the WOMAC index. However, the within-group comparison pointed to a significant improvement in all the WOMAC domains in both groups from baseline to 6 months. The effectiveness of Channa striatus shows no difference from that of glucosamine sulphate in reducing the symptoms of knee osteoarthritis. Channa striatus could be a new alternative treatment for the management of knee osteoarthritis.

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

<p class="abstract"><strong>Background:</strong> The study is to compare the immediate post operative outcomes of sequential bilateral versus unilateral total knee replacement (TKR) for the treatment of primary knee osteoarthritis. Study comprised of 96 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral and sequential bilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and duration of hospital stay, post operative mobilisation, fall in haemoglobin level immediate post operative, need for blood transfusion, post operative complications, post operative pain and duration of surgery was recorded. The results were statistically compared. The mean duration of hospital stay, post operative blood loss in terms of fall in HB, post operative pain control, need of transfusions and duration of surgery revealed statistically significant differences.</p><p class="abstract"><strong>Methods: </strong>Total 96 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 operated with sequential bilateral TKR under single anaesthetic procedure and group 2 with unilateral TKR both operated by same surgeon and anaesthetist.</p><p class="abstract"><strong>Results: </strong>It was observed that longer duration of surgery and hospital stay, higher fall in HB levels, increased need of analgesics and higher requirement of blood transfusions were associated with group 1 as compared to 2. Complication rates and post op mobilisation was similar in both groups.</p><p class="abstract"><strong>Conclusions: </strong>Sequential bilateral TKR is a viable option for patient with symptomatic bilateral knees but patient selection and pre op counselling takes the priority. </p><p class="abstract"> </p>

Strontium ranelate as new modality in treatment of primary knee osteoarthritis

Background: Osteoarthritis is a degenerative disease that has an effect on the whole joint structure which includes the synovial layer, cartilage, subchondral bone, ligaments and muscle groups across the joint. Objective: to evaluate effectiveness of strontium ranelate in treatment of patients with primary knee osteoarthritis (KOA). Methods: This randomized clinical trial was done on 30 patients with bilateral Knee osteoarthritis, they were divided into 2 groups. Group 1: 15 patients received strontium ranelate 2 gram and physiotherapy programme. Group 2:15 patients received physiotherapy programme only. All patients were assessed using visual analogue scale for pain (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and knee MRI. Results: This study included 45 patients with Knee osteoarthritis, 15 patients were excluded based on exclusion criteria, only 30 patients were randomized into 2 groups, 1 patient in group 1 and 2 patients in group 2 didn't complete follow up duration, and statistical data were done only on 27 patients. At the beginning of the study no significant difference was found between both groups in all parameters. A significant improvement in VAS and WOMAC score was found in group 1(p=0.034,p=0.004) in comparison to group 2 after 6 months follow up. There was statistically significant improvement in group 1 in synovitis/effusion detected by MRI in comparison to group 2 after 6 months of treatment. Conclusion: Strontium ranelate (SrR) has great role in reducing pain, synovitis, improving function in primary knee osteoarthritis and could be considered a disease modifying osteoarthritis drug.

Early Clinical and Functional Outcome of Primary Total Knee Replacement with Posterior Cruciate Substituting Prosthesis for Primary Knee Osteoarthritis Using 2011 Knee Society Score

Background: Primary knee Osteoarthritis (OA) is the commonest articular disease in middle age and elderly people. Primary total knee replacement (TKR) is a known world-wide standard and definitive treatment of primary knee OA following failed adequate non-operative management. It is of clinical importance to assess the clinical and functional outcome of TKR to prognosticate the severity of primary knee OA. The new (2011) knee society scoring system (nKSS) is both surgeons and patients’ assessment tool for the treatment outcome of TKR. Study Design: Prospective interventional analytical study. Aim and Objective: The aim of the study was to determine early clinical and functional outcome of primary total knee replacement in patients with primary knee osteoarthritis using nKSS. The objectives were: 1) To determine the pre-operative nKSS and post operative nKSS; 2) To determine relationships between pre-operative nKSS and post operative nKSS at 6 weeks, 3, 6, 9 and 12 months; 3) To determine the complication rates in patients undergoing primary TKR in the study centre. Methods: A prospective interventional study of 59 patients aged 51 to 70 years who had 67 Total Knee Replacements (TKRs) participated in the study between November 2015 to June 2018 at National Orthopaedics Hospital, Lagos, Nigeria. Patients’ sociodemographic data, pre-operative and post-operative nKSS system were recorded at 6 weeks, 3, 6, 9 and 12 months during follow up. The data were analyzed using Statistical Package for Social Science (SPSS). Results: There were 41 females and 18 males (M:F = 1:2.3). There were total of 67 TKRs with 31 right TKRs, 20 left TKRs and 8 staged bilateral TKRs. The participants’ age ranged from 51 to 70 years with the mean age of 59.5 (±8.5) years. Four patients did not complete the study due to various reasons. The remaining 55 participants completed the study period with progressive improvement of their post-operative nKSS at 6 weeks, 3, 6, 9 and 12 months post-operatively when compared with pre-operative nKSS (P value 0.5). Conclusion: This study revealed improved early clinical and functional outcome of primary total knee replacement in primary knee osteoarthritis using nKSS in all the studied patients. There is no significant negative effect of lower pre-operative nKSS (and its components) on the post-operative nKSS outcome.

Comparison in Efficacy and Safety of Koklan Mixture Formula 3 and Diclofenac for Pain Relieving in Primary Knee Osteoarthritis

Knee Osteoarthritis is a common disease in aging society. In general, Diclofenac which belongs to Nonsteroidal Anti-inflammatory drugs, has analgesic and Anti-inflammation effects. Although Diclofenac is often prescribed, it conveys high incidence of side effects especially in stomach ulcer. Therefore, the researcher realizes the importance of using the Koklan Mixture Formula 3 which is National Drug Information to replace the using of foreign medicine. The objective of this research was 1) to study comparison of efficacy of the Koklan Mixture Formula 3 and Diclofenac 2) to study safety of the Koklan Mixture Formula 3 and Diclofenac in reducing pain in primary osteoarthritis 3) to study the effectiveness of the Koklan Mixture Formula 3. Research methodology was a Randomize-double blinded, controlled trial at Suan Sunandha Medical Clinic, with criteria for selection of volunteers aged 50-70 years of knee pain no more than moderate using randomize-double blinded, controlled trial. According to the Oxford Knee Score evaluation, 68 subjects using random sampling method, blocked Randomization divided into 2 groups, consisting of 34 patients received the Koklan Mixture Formula 3 dose 30 cc before 3 meals and 34 received Diclofenac 25 mg after 3 meals for 14 days. In this study showed that the Koklan Mixture Formula 3 and Diclofenac were efficient and safe for the treatment of primary knee osteoarthritis and there were no differences statistically significant. Beside Koklan formular 3 also has effect on muscle relaxation, reduce edema and the blood nourishment.

Intra articular methylprednisolone acetate injection efficacy in the treatment of primary knee osteoarthritis at Hue Central Hospital and Hospital of Hue University of Medicine and Pharmacy

Introduction/Background: Osteoarthritis is still an incurable disease, the current treatment is to reduce clinical symptoms. The intra articular glucocorticoid injection in knee osteoarthritis makes the inflammatory process self-limiting and improves pain symptom. Objectives: To evaluate the efficacy and safety of intra articular methylprednisolone acetate injection in treatment of primary knee osteoarthritis. Materials and Methods: Prospective descriptive study of 88 knee joints (34 joints in study group, 54 joints in control group) was diagnosed with primary osteoarthritis according to the American College of Rheumatology (ACR) classification criteria and in Kellgen & Lawrence grade II, III. The patient was assessed about clinical features, subclinical features and the VAS score, Lequesne index at the initial of the study and 7 days later. Results: The analgesic effect was higher in the group of intra articular methylprednisolon injection with statistically significant difference (∆VAS of the study group and the control group were 38.65 ± 9.25; 25.11 ± 9.26, respectively, with p < 0.05). The improving of knee function was higher in the group of intra articular methylprednisolon injection with statistically significant difference (∆Lequesne of the study group and the control group were 7.00 (5.00 – 8.00); 4.00 (3.00 – 5.00), respectively, with p < 0.05). The incidence of complications in the study group was 1/34 (2.94%) with post – injection pain. The improvement of VAS is better in patient with severe pain than those with moderate pain (p < 0.05) and correlated to the initial value of Lequesne (r2 = 0,162, respectively, with p < 0.05). The improvement of Lequesne correlated to the joint fluid thickness in ultrasound (r2 = 0.102, p < 0.05). There is no relation between efficacy of treatment and site of knee joint, radiology stage and synovial membrane thickness (p > 0.05). Conclusions: The intra articular methylprednisolone acetate injection in treatment of primary knee osteoarthritis is a safe treatment and has significant, clearly effect in pain relief and physical function improving after 7 days. The improvement of VAS is better in the patient with higher initial value of VAS, Lequesne and the improvement of Lequesne is better in the patients with more synovial thickness in ultrasound. Key words: Knee osteoarthritis, intraarticular injection, methylprednisolon acetate

Effects of Platelet Rich Plasma in Combination with Hyaluronic Acid in the Treatment of Primary Knee Osteoarthritis

Background: Platelet Rich Plasma (PRP) is increasingly applied in clinical practice to treat knee degenerative pathology. Both PRP and hyaluronic acid (HA) have been extensively used to improve lubrication, modulate inflammation and modify the catabolic micro-environment of the joint.
 Objective: This study was aimed to evaluate the potential synergistic effects of PRP in combination with hyaluronic acid in primary knee osteoarthritis.
 Methodology: This randomized control trial was carried out on adult patients with primary knee osteoarthritis who attended the Pain Clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during the period of September 2015 to August 2017. The patients were randomly assigned to one of the two groups designated as group P (control group) who were only treated with PRP and group PH (experimental group) who were treated with the combination of PRP and hyaluronic acid. After providing the allocated treatment, all patients were undergone follow-up examination at 1st week, 1st month and 3rd month for pain improvement by VAS scale and for functional improvement by International Knee Documentation Committee (IKDC) score.
 Results: A total number of 34 patients were recruited for this study. Visual analogue score 1st month (5.85±0.83) and 3rd month (3.01±0.12) follow up showed statistically significant difference among two group (p=0.001). Inter group comparison showed that, mean VAS score of group PH (3.01±0.12) decreased more than Group P (4.01±1.01). In case of functional improvement, group PH also showed statistically better improvement during 1st month (45.76±3.25) and 3rd month (62.06±5.37) follow up than Group P.
 Conclusion: In conclusion articular platelet rich plasma in combination with hyaluronic acid provide better pain relief and improvement of functional status than PRP therapy alone in primary knee osteoarthritis.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 137-142

The Effect of Shock Wave Therapy as a New Modality for Treatment of Primary Knee Osteoarthritis

Background: osteoarthritis, the most common form of arthritis, is a chronic disease characterized by slow degradation of cartilage, pain, and increasing disability. Objective: to study the effect of shock wave therapy in treatment of primary knee osteoarthritis. Patients and Methods: thirty patients with primary knee osteoarthritis were classified equally into 2 groups according to the line of treatment; Group I received extra-corporeal shock wave therapy and Group II received continuous ultrasonic waves. Patients were evaluated for pain using visual analogue scale, active range of motion, and physical and functional assessment. Bilateral anteroposterior weight bearing radiographs were done for all patients before treatment and degree of osteoarthritis was assessed by Kallgren and Lawrence Radiographic criteria. Results: there was significant improvement in group I more than group II (as regard to pain assessed by visual analogue scale (VAS) after treatment (p=0.039) and in follow up (p <0.001). There was significant improvement in morning stiffness in both groups with insignificant difference between both them. Regarding active range of motion (ROM), there was significant improvement in flexion in both groups with significant difference between both groups before and after treatment (p =0.001) and in follow up (p <0.001). Regarding chair stand test, there was significant improvement in both groups with in significant difference between them. Regarding stair climb test (SCT), there was significant improvement in both groups with insignificant difference between them. Conclusions: shock wave had an effect in treatment of primary knee OA as a new modality for improving clinical and functional performance.

Low-dose intra-articular autologous conditioned serum in treatment of primary knee osteoarthritis

BackgroundInterleukin-1 (IL-1) plays an important role in the pathogenesis of osteoarthritis. Hence, agents that inhibit such cytokine have a high therapeutic potential. A method of therapy depends on competitive inhibition of IL-1 at the receptor level – that is, IL-1 receptor antagonist; such antagonist is called Orthokin, which is a normal product of monocytes and is prepared within autologous conditioned serum (ACS) from the patient’s own blood cells. It is capable of blocking the effects of IL-1, including the induction of matrix metalloproteinases, prostaglandin E2 synthesis, and expression of other cytokines.ObjectiveThe aim of the study was to clinically evaluate the effect of intra-articular injection of low-dose ACS enriched with Orthokin on primary knee osteoarthritis to assess its validity in treatment.Patients and methodsThis study included 30 knees with primary osteoarthritis. Baseline clinical evaluation using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score was performed. Then ACS enriched with Orthokin (IL-1 receptor antagonist) was prepared. The knee joint was injected with 1 ml ACS weekly for 3 successive weeks. Patients were assessed using WOMAC questionnaire (1 week after each injection for 3 weeks and monthly after the last injection for 3 months).ResultsOn comparing WOMAC score with baseline data, there was a highly significant improvement in all scores, where P was less than 0.01 during all assessment periods and improvement persisted until the end of follow-up after 3 months in comparison with baseline data.ConclusionThe synthesis and introduction of interleukin-1 receptor antagonists derived from own blood cells established a promising strategy in the treatment of osteoarthritis.

Zaltoprofen, a noninferior alternative to diclofenac for the treatment of primary knee osteoarthritis – a comparative evaluation of efficacy and safety in a 4-week, multicentric, randomized, double-blind, double-dummy trial

Objective: To demonstrate the clinical noninferiority of the analgesic effect of zaltoprofen (80 mg t.i.d.) compared with diclofenac (50 mg t.i.d.) in active knee osteoarthritis patients.Method: In this multicentric, double-blind, double-dummy, randomized, parallel-group, comparative study, 213 patients of either sex, aged 40 – 65 years having radiological and clinically confirmed primary knee osteoarthritis were randomized either to zaltoprofen (n = 105) or diclofenac (n = 108) and were followed-up at weeks 1, 2, 3 and 4. The treatment period was preceded by a washout period of 1 week.Results: Patients in both the zaltoprofen and diclofenac groups exhibited significant improvement (p < 0.001) in pain intensity, functional status and pain relief at each visit from baseline with no statistically significant difference between the two treatment groups. There was no statistically significant difference between the treatment groups for global assessment rating done by the patient and investigator at the end of therapy (p > 0.05) and the proportion of patients who consumed ranitidine (p = 0.135) and paracetamol (p = 0.086) tablets during the treatment period on both the treatment arms. Both the study medications were well tolerated with no incidence of serious adverse events.Conclusions: This study demonstrated that efficacy and safety of zaltoprofen is clinically noninferior to that of diclofenac.

Knee osteoarthritis and obesity.

To assess the risk of knee osteoarthritis (OA) attributable to obesity, and the interactions between obesity and other established causes of the disorder. We performed a population-based case-control study in three health districts of England (Southampton, Portsmouth and North Staffordshire). A total of 525 men and women aged 45 y and over, consecutively listed for surgical treatment of primary knee OA, were compared with 525 controls matched by age, sex and family practitioner. Relative to a body mass index (BMI) of 24.0-24.9 kg/m(2), the risk of knee OA increased progressively from 0.1 (95% CI 0.0-0.5) for a BMI<20 kg/m(2) to 13.6 (95% CI 5.1-36.2) for a BMI of 36 kg/m(2) or higher. If all overweight and obese people reduced their weight by 5 kg or until their BMI was within the recommended normal range, 24% of surgical cases of knee OA (95% CI 19-27%) might be avoided. As a risk factor for knee OA obesity interacted more than additively with each of Heberden's nodes, earlier knee injury and meniscectomy. In comparison with subjects of normal weight, without Heberden's nodes, and with no history of knee injury, people with a combination of obesity, definite Heberden's nodes and previous knee injury had a relative risk of 78 (95% CI 17-354). Our findings give strong support to public health initiatives aimed at reducing the burden of knee OA by controlling obesity. People undergoing meniscectomy or with a history of knee injury might be a focus for targeted advice.