Western Ontario McMaster Osteoarthritis Index Research Articles

Effectiveness of Bacillus genus application in the treatment of osteoarthritis by bioactive fish concentrate

Background. Understanding the impact of gut microbiota on the development of osteoarthritis (OA) and investigating the potential of probiotics as a treatment remain crucial areas of research. The study aimed to evaluate the efficacy of a Bacillus-based probiotic in combination with a bioactive marine fish concentrate for the OA treatment. Materials and methods. This study included 38 patients diagnosed with grade II knee OA. A structural-modifying drug containing 0.2 ml of bioactive concentrate derived from small marine fish, was administered every other day in a dose of 2.0 ml (10 intramuscular injections in total) for 21 days. Twenty patients (main group) additionally received a probiotic containing bacteria of the genus Bacillus (B.subtilis, B.licheniformis, B.amyloliquefaciens, B.megaterium, B.pumilus) in the dosage form of oral suspension daily for the entire treatment period of 21 days. Clinical efficacy was assessed by the Western Ontario McMaster Osteoarthritis Index (WOMAC), the questionnaire was comple­ted by all patients before the study and after 3, 7, 14 and 21 days of the therapy. Results. The findings showed a significant reduction in pain by 40.6 % (p < 0.001), stiffness by 36.8 % (p < 0.001), and improvement in knee function by 26.6 % (p < 0.05) in the main group (undergoing combined therapy with bioactive fish concentrate and the probiotic) on the 7th day of treatment. In the comparison group, a decrease in pain by 27.4 % (p < 0.05), stiffness by 25.0 % (p < 0.05), and improvement in joint function by 28.9 % (p < 0.05) were observed only on the 14th day of therapy. Conclusions. It was demonstrated that administering a probiotic composition containing bacteria from the genus Bacillus enhances the efficacy of bioactive sea fish concentrate in treating OA. Reduction in pain, stiffness, and improvement in joint function can be observed as early as the 7th day after initiating their combined use. In contrast, when using the bioactive concentrate of marine fish alone, the clinical effect is typically observed by the 14th day of treatment.

Revision of Failed Short Stems in Total Hip Arthroplasty.

Background: The current literature lacks studies which evaluate the failure of short stems in total hip arthroplasty (THA). Therefore, the present clinical investigation reported our experience with the failure of short stems in THA, evaluating the causes of failure, survivorship, and the clinical outcomes of revision arthroplasty. Methods: The present study was performed according to the STROBE guidelines. This study was conducted at the Department of Orthopaedic Surgery of the Humanitas Clinical Institute, Milan, Italy, between 2017 and 2022. All patients who underwent revision surgery of a previously implanted THA using a short stem were prospectively included in the present study. Surgeries were performed with patients in lateral position, using a minimally invasive posterolateral approach. The outcomes of interest were to report information on the type and survivorship of implants used for the revision surgery and evaluate the clinical outcomes and the rate of complications. The following patient-reported outcome measures (PROMs) used for the clinical assessment were the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) and related subscales of pain, stiffness, and function, and the visual analogue scale (VAS). Results: Data from 45 patients were retrieved. Of them, 31% (14 of 45 patients) were women. The mean age was 63.7 ± 13.9 years. The mean length of the implant survivorship was 6.2 ± 5.7 years. In total, 58% (26 of 45 patients) underwent revision of all components, 36% (16 of 45 patients) revised only the stem, and 1% (3 of 45 patients) received a two-stage revision. The mean length of the follow-up was 4.4 ± 1.5 years. The cup was revised in 58% (26 of 45) of patients. At 4.4 ± 1.5 years of follow-up, the WOMAC score was 3.5 ± 1.3 and the VAS was 1.2 ± 1.3. In total, 9% (4 of 45) of patients experienced minor complications. One patient used a walking aid because of reduced function. One patient evidenced muscular hypotrophy. Two patients experienced hip dislocations. All two dislocations were managed conservatively with repositioning in the emergency room under fluoroscopy. No patient needed additional revision surgery or experienced further dislocations. Conclusions: Revision surgery is effective and safe when a short stem THA fails. At approximately four years of follow-up, all patients were highly satisfied with their clinical outcomes. Despite the relatively high number (9%), complications were of a minor entity and were successfully managed conservatively.

Qualitative and Quantitative Measures in the Infrapatellar Fat Pad in Older Adults: Associations with Knee Pain, Radiographic Osteoarthritis, Kinematics, and Kinetics of the Knee

ObjectiveThe purpose of this study is to delineate cross-sectional associations between qualitative and quantitative measures of the infrapatellar fat pad (IPFP) and knee symptoms, structure, kinematics, and kinetics in older adults. MethodsNinety eligible subjects (90 knees, mean age 54.0 years, 68.9% female) were examined at our centre. We used T2-weighted fat-suppressed magnetic resonance imaging (MRI) to evaluate signal intensity alteration, maximum sagittal area, and depth of the IPFP. Symptomatic osteoarthritis (SOA) was a pain subscale score greater than 0 on the Western Ontario McMaster Osteoarthritis Index. A Kellgren-Lawrence grade ≥ 2 identified incident radiographic osteoarthritis (iROA). Three-dimensional gait data were employed to analyze knee joint kinematics and kinetics. Correlation and regression analyses assessed associations between IPFP measurements and SOA, iROA, kinematics, and kinetics. ResultsThere were strong and positive associations between IPFP signal intensity alteration and both SOA and iROA in multivariable regression analyses [OR (95% CI): 2.849 (1.440 to 5.636), 2.356 (1.236 to 4.492), respectively]. Conversely, a significant negative correlation was observed between IPFP maximum area and flexion angle [B (95%CI): -1.557 (-2.549 to -0.564)]. Moreover, adjusting for covariates did not reveal any significant correlation between IPFP parameters and other indicators (P > 0.05, respectively). ConclusionIPFP signal intensity alteration and area were associated with knee clinical symptoms, structural abnormalities, and flexion angle in adults over 40, respectively. These findings suggest that IPFP may be a crucial imaging biomarker in early and middle knee osteoarthritis.

Clinical outcomes of modified direct lateral approach of Hardinge for total hip arthroplasty.

The aim of the study was to evaluate a modified direct lateral approach for total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization. We retrospectively reviewed the data of 526 patients with THA operated in our department between January 2017 and December 2021. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively and postoperatively at 3 days, 6 weeks, 12 weeks and 1 year and we registered surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index. Low intraoperative blood loss, short operation time, short hospitalization, early mobilization of the patient and good range of motion imposed the modified direct lateral approach as a valuable procedure for the patients with THA. VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results. Trendelenburg gait and abductor weakness, traditionally related with direct lateral approach, were not significant statistically and complete reversible. We registered a very low complication rates with good functional outcome. The modified direct lateral approach can lead to superior outcomes, improved quality of life, with reduced intra and postoperative complications rate.

Evaluation of Total Hip Arthroplasty Performed from a Lateral Approach as Optimal Treatment for Femoral Neck Fractures in Elderly, Active Patients

Background. The aim of the study was to evaluate total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization, as a treatment of choice for displaced femoral neck fractures.Materials and methods.We retrospectively reviewed the data of 526 patients with THA operated on in our department between January 2017 and December 2021. Clinical examinations, functional outcome assessment and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: postoperatively at 3 days, 6 weeks, 12 weeks and 1 year, and we recorded surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index, and range of motion. Results. Low intraoperative blood loss, short surgical time, short hospitalization, early mobilization of the patient and a good range of motion testify that the modified direct lateral approach is a valuable procedure for the patients with THA. A VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results. Conclusion. THA for active patients with a displaced fracture of the femoral neck is an excellent treatment option which provides lasting pain relief, a high level of function and very low rates of reoperation.

Efficacy and Safety of Undenatured Type II Collagen in The Treatment of Osteoarthritis of The Knee: A Randomized, Double-blind, Placebo-controlled Trial

BACKGROUND: Available medication for pain and joint stiffness release in osteoarthritis (OA) often gives considerable side effects. Undenatured type II collagen (UC-II) has been considered as a treatment for OA for its ability to prevent the progress of articular cartilage damage. Hence, this study aimed to evaluate the efficacy and safety of UC-II in modulating knee joint function.METHODS: This was a randomized, double-blind, placebo-controlled study involving 102 OA subjects. Subjects were randomized into two groups: receiving an oral daily dose of 40 mg/day UC-II or placebo containing microcrystalline cellulose for 90 days. Efficacy was evaluated by using the Western Ontario McMaster Osteoarthritis Index (WOMAC), Lequesne’s Functional Index (LFI), and Visual Analogue Scale (VAS) score on day-1, -7, -30, -60, and -90. Safety was evaluated by assessing the adverse events (AEs) and abnormal laboratory findings.RESULTS: The WOMAC total score showed a significant difference between the UC-II group vs. the placebo group from day-7 (p<0.05) to day-90 (p<0.01). UC-II was more effective in reducing the WOMAC total scores by 81.6% compared to 19.2% in the placebo group after 90 days. The total LFI and VAS score was significantly reduced in subjects supplemented with UC-II compared to the placebo group (75.8% vs. 7.8%; 67.9% vs. 12.2%, respectively). No significant changes were observed in vital signs and clinical laboratory tests compared to the placebo. The UC-II had a good safety profile with no serious adverse events among participants.CONCLUSION: UC-II significantly improved the knee pain, stiffness, and functional mobility of OA patients and was well-tolerated.KEYWORDS: osteoarthritis, undenatured type II collagen, WOMAC, VAS, LFI

The sodium does not affect joint pain and functional activity of knee osteoarthritis patients.

The sodium may aggravate synovial inflammation and cartilage thinning. This incidence can cause joint pain and reduce functional activity. Not many people know the effect of sodium on the incidence of osteoarthritis. This study aims to determine the relationship between sodium in the body and knee joint pain which results in functional activity. The quantitative descriptive study used accidental sampling. The study was conducted at three outpatient polyclinic orthopedics of hospitals and was approved by the Health Ethics Committee. All data were collected during the interview. The Semi-Quantitative Food Frequency Questionnaire and the Nutrisurvey Indonesia 2007 application were used as a tool to collect daily sodium intake (mg). Knee joint pain score was measured using the Visual Analog Scale (VAS), while functional body activity was measured using the Western Ontario McMaster Osteoarthritis Index (WOMAC). The Pearson and Spearman test (P<0.05) were used as a correlation test. 80 subjects were recruited according to the inclusion criteria. Characteristics of the subjects were pre-elderly (32, 40%), women (74, 92.5%), body mass index ≥30 kg/m2 (54, 67.5%) and occupation (43, 53.75%). Average sodium intake = 2090.78±1084.33 mg, VAS score = 6.28±1.95 and WOMAC score = 32.65±14.88. The correlation sodium, VAS, and WOMAC were not significant (P=0.196, P=0.372). Increased sodium intake is not associated with knee joint pain and functional body activity.

Comparison of Radial Pressure Waves and Focused Extracorporeal Shock Waves in Treatment of Osteoarthritis of the Knee

Objective: The aim of this study is to investigate and compare the clinical efficacy of radial pressure waves and focused external shock wave therapy for knee osteoarthritis (KOA). Materials and Methods: From October 2020, 90 patients aged 45–65 years old with Kellgren and Lawrence classification (K-L) stage I and II of KOA were selected in our hospital or randomly assigned to 3 groups with 30 cases in each group. One group was treated with antiinflamatory medication. The other two groups received one course of treatment (once a week, 4 times in total) performed by using radial focused shock waves respectively, and follow-up was conducted by telephone and outpatient review 3, 6, and 9 months after the treatment. Visual Analog Scale (VAS) and Western Ontario McMaster Osteoarthritis Index (WOMAC) osteoarthritis score were used before and after treatment. Results: (1) VAS, WOMAC, and evaluation indexes of both treated groups were better than those of the control group (oral drug group); (3) The score of the radial group was significantly different from that of the focused group (P &gt; 0.05). Conclusion: (1) Focused and radial pressure waves (RPW) have good clinical therapeutic effect on early KOA (2) Comparison of long-term effect: focused shock waves are more significant than radial (3) Radial pressure waves area good indication in relatively young patients, short course of disease (within 1 year), and K-L stage I an II. (4) In older patients, with more than a year of symptoms and K-L stages II and III, focal waves are more effective than radial waves. (5) Patients with acute onset and night pain or accompanied by obvious effusion can first take nonsteroidal drugs orally continuously for a week, and the treatment effect is better. During treatment, the drugs can be continued or stopped according to the specific conditions. When synovial edema and effusion of the joint decreased, the conventional parameters were used for treatment. Keywords: Knee osteoarthritis, Extracorporeal shock wave therapy, Radial Pressure Waves

The Impact of Chronic Pain, Stiffness and Difficulties in Performing Daily Activities on the Quality of Life of Older Patients with Knee Osteoarthritis.

Osteoarthritis causes a number of physical ailments, which result in the deterioration of a persons' general health and reduction of their ability to move freely. This cross-sectional study was designed to assess the impact of physical ailments in the course of knee osteoarthritis (KOA) on the quality of life (QoL) of patients in early old age. An anonymous survey was conducted by the use of the recognized research tools: Western Ontario scale and McMaster Osteoarthritis Index (WOMAC), The Index of Severity for Knee Disease (ISK) and World Health Organization Quality of Life-BEFF (WHOQOL-BREF). The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without lower limb complaints. The significant intensification of the symptoms of knee osteoarthritis was associated with a worse assessment of health (p &lt; 0.001), overall quality of life (p &lt; 0.001) and in the following domains: physical (p &lt; 0.001), mental (p &lt; 0.001) and environmental (p &lt; 0.001) in a group of patients with KOA. These findings suggest that taking measures to reduce knee pain and improve function may have an impact on improving the overall quality of the life of people in their early old age.

Self-education Program for Osteoarthritis Reduces Sodium Intake, Knee Joint pain, and Serum Interleukin-17A level in Osteoarthritis Patients

Objectives: As it has been known that sodium may aggravate joint inflammation throuh IL-17A pathway and it can cause joint pain, the purpose of this study was to determine the effect of the Self Education Programs for Osteoarthritis (SEPO) intervention on sodium intake, knee join pain and IL-17A level in patients with knee osteoarthritis.&#x0D; Methods: This multicenter study was conducted in orthopedic and internal medicine outpatient wards in three hospitals. This research has received ethical approval. Patients were recruited based on accidental sampling, who met the inclusion criteria. SEPO intervention was carried out for 30 days, followed by provision of leaflets, posters, and handbook about osteoarthritis, daily WhatsApp education chat and/or video. Patients’ demographic, knee joint pain, and sodium intake data was collected during interview, using the Semi Quantitative Food Frequency Questionnaire (SQ_FFQ), and WOMAC (Western Ontario McMaster Osteoarthritis Index) whereas serum IL-17A was determined by using ELISA. The effect of SEPO was analyzed statistically using Mann Whitney tests (p&lt; 0.05).&#x0D; Results: Total subjects recruited were 80, namely 30 patients in control group and 50 patients in treatment group. Majority of patients were female (74, 92.5%), age 56-65 yo (32, 40%), obese (54, 67.5%) and senior high school (23, 46%). Statistical results showed that following SEPO intervention daily sodium intake was lower (1289.45±457.98 mg) compared to the control group (2143.94±744.75 mg), p= 0.04. WOMAC score of control group (28±12.41) higher than treatment group (23.88±13.61), p=0.02. Serum IL-17A levels were also lower in the treatment group (3.974±1.06 pg/mL) than the control group (5.542±1.99 pg/ml), p=0.01.&#x0D; Discussion: Education as a non-pharmacological therapy is needed to reduce disease progression. Education is provided according to the patient's needs. Educational models can be offline (face to face) or online (digital). SEPO intervention in patients with knee osteoarthritis can reduce sodium intake, knee joint pain, and may impact on reduction of serum IL-17A.&#x0D;

Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial.

Total knee arthroplasty (TKA) is one of the most successful procedures for the treatment of severe knee osteoarthritis. Various surgical approaches have been investigated in the hopes of improving postoperative outcomes. Two include the medial parapatellar (standard) and midvastus. As the midvastus approach does not disrupt the extensor mechanism, it may be advantageous for functional recovery, however length of stay and long-term function are similar between approaches. Tourniquet use during TKA has conflicting results in the literature. We hypothesized that a future trial comparing outpatient versus standard TKA could appropriately use either surgical approach with or without a tourniquet. Therefore, the objective of this pilot randomized trial was to compare postoperative pain, function, quality of life, and satisfaction between patients who underwent a medial parapatellar or midvastus approach for TKA ± tourniquet use. We conducted a randomized trial with a two-by-two factorial design to compare the medial parapatellar to the midvastus surgical approach for TKA ± tourniquet use. The Short Form-12 (SF-12), Western Ontario McMaster Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) were collected at baseline, postoperatively at two, six, 12 weeks, and one year. Eighty-three patients were included. Postoperative WOMAC scores were statistically but not clinically higher at six weeks and three months in favour of no tourniquet use. There were no differences in postoperative WOMAC scores between approaches. Short Form-12 and KSS scores increased in both groups with no significant differences postoperatively (p > 0.05). There were no clinically significant differences in postoperative pain, function, quality of life, or satisfaction between surgical approaches or whether a tourniquet was used. As such, both surgical approaches ± tourniquet use are safe and reliable. We believe a future larger randomized trial could likely incorporate either surgical approach or tourniquet preferences without significant impact on patient reported outcomes.

Formulation and Evaluation of Diclofenac Potassium Gel in Sports Injuries with and without Phonophoresis.

Background: Pain remains a global public heath priority. Phonophoresis, also known as sonophoresis or ultrasonophoresis, is when an ultrasound is used to maximize the effects of a topical drug. Purpose: The objective of this study was to test, in patients injured in sports or accidents (N = 200), the efficacy of diclofenac potassium (DK) 6%, 4%, and 2% formulated gels with and without phonophoresis in comparison with market available standard diclofenac sodium (DS or DN) gel. Methods: The patients were enrolled after informed consent. By using the lottery method, 100 patients were randomly segregated into five groups without phonophoresis and repeated similarly with phonophoresis at a frequency of 0.8 MHz, an intensity of about 1.5 W/cm2, and at continuous mode (2:1). Group-1 was treated with 6% DK gel, group-2 was treated with 4% DK gel, group-3 was treated with 2% DK gel, group-4 was treated with 4% DS gel and group-5 was given control gel three to four times a week for 4 weeks. The patients were screened by using NPRS and WOMAC scales. They were assessed on the baseline, 4th session, 8th session, 12th session, and 16th session. Results: Significant dose-dependently relief was observed in NPRS (Numeric Pain Rating Scale) and the WOMAC (Western Ontario McMaster Osteo-Arthritis) index for pain in disability and stiffness for each group treated with DK gel compared to DS gel. Phonophoresis increased these benefits significantly when used after topical application of DK gel or DS gel, and the dose-dependent effects of DK gel plus phonophoresis were stronger than the dose-dependent effects of DS gel plus phonophoresis. The faster and profounder relief was due to phonophoresis, which allows more penetration of the DK gel into the skin as compared to the direct application of DK gel in acute, uncomplicated soft tissue injury, such as plantar fasciitis, bursitis stress injuries, and tendinitis. In addition, DK gel with phonophoresis was well tolerated. Thus, in this personalized clinical setting, according to the degree of inflammation or injured-induced pain, disability, and stiffness, DK gel 6% with phonophoresis appeared more effective and thus more recommendable than DS gel 6% alone or DS gel 6% combined to phonophoresis.

Rubus idaeus extract improves symptoms in knee osteoarthritis patients: results from a phase II double-blind randomized controlled trial

BackgroundOsteoarthritis (OA) is the most frequent cause of disability in elderly people. In daily practice, the main objective of the physician is to reduce patient symptoms using treatments without adverse effects. However, the most prescribed treatment to manage OA symptoms remains nonsteroidal anti-inflammatory drugs which are associated with severe adverse effects. Therefore, we need a safe alternative to managing OA. One candidate is Rubus idaeus leaf extracts known to inhibit inflammatory responses.ObjectiveThis study aimed to evaluate the effects of a 12-weeks intervention with an ethanolic extract from Rubus idaeus leaf on symptoms of knee osteoarthritis.MethodThe study was a randomized, double-blind, placebo-controlled, monocentric trial of 198 participants with femorotibial osteoarthritis. Participants were randomized equally to receive one daily during 3 months either 1 capsule of Rubus idaeus leaf extract 400 mg, 1 capsule of Rubus idaeus leaf extract 200 mg, or 1 capsule of placebo. The participants were assessed at baseline and after one and three months of treatment. The primary endpoint was an absolute change of the Western Ontario McMaster osteoarthritis index (WOMAC) pain subscale. The secondary endpoints were WOMAC global score, stiffness and function sub-scales, knee pain VAS score at walking, the Short Form (SF)-36, the Short Physical Performance Battery (SPPB), the 20-m walk test, and the International Physical Activity Questionnaire (IPAQ) and Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) responders rate. Statistical analyses were conducted on the intent-to-treat (ITT) population.ResultsIn the Intention-to-treat population, WOMAC pain was not significantly modified by Rubus idaeus leaf extract compared to placebo. In contrast, Rubus idaeus leaf extract 400 mg after 12 weeks of treatment significantly reduced pain measured by the VAS. The mean pain decrease induced by Rubus ideaus leaf extract was over -7 mm which is clinically relevant and reached a clinically statistical difference compared to placebo with the highest dose. Rubus Ideaus was not significantly more efficient than the placebo on WOMAC global score, stiffness, and physical function subscores, IPAQ, SF-36, walking distance in treadmill test, SPPB, and evaluation of associated treatments needed to manage OA.ConclusionRubus idaeus leaf extract was well tolerated and effective to relieve pain in a patient with knee osteoarthritis.Trial registrationNCT03703024 (11/10/2018).

Mid- to long-term results of modified avascular fibular grafting for ONFH.

Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. This study analyzed the mid- to long-term outcomes of avascular fibular grafting (AVFG) for osteonecrosis of the femoral head (ONFH) with 6- to 8-year follow-up. From March 2009 to March 2012, 34 patients (48 hips) were diagnosed with ONFH operated with AVFG in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic outcomes of these patients and evaluated the differences in outcomes by diverse stages [Association Research Circulation Osseous (ARCO)] and types [China–Japan Friendship Hospital (CJFH) classification] annually. The hip survival rate, Harris hip score (HHS), activity level and imaging stability were calculated. The average follow-up time was 6.7 years. At the last follow-up, 34 of 48 hips survived totally. According to the ARCO stage, the overall clinical success rate for hip preserving were 76.0% (19/25) in II stage, 85.7% (12/14) in IIIA stage and 33.3% (3/9) in IIIB stage. Referring to the CJFH classification system, the hip survival rate were 100% (2/2) in M type, 90.9% (10/11) in C type, 77.8% (14/18) in L1 type, 57.1% (8/14) in L2 type and 0% (0/3) in L3 type. The mean visual analog scale (VAS) score, HHS and Western Ontario McMaster Osteoarthritis index (WOMAC) were significantly improved at the final follow-up compared with pre-operative values (P < 0.001). The AVFG operation can increase the hip function and improve patients’ lives quality. The mid- to long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty surgery.

Impact of Depressive Symptomology on Pain and Function during Recovery after Total Joint Arthroplasty.

To determine the effect of preoperative depressive symptoms on patient-reported function and pain following total joint arthroplasty (TJA) after controlling for potential confounding factors; how depressive symptoms changed after TJA; and the impact of postoperative depressive symptoms on recovery. A prospective cohort study undertaken in a metropolitan region in Canada enrolled 710 participants; 622 (87%) had complete 6-month data. Participants completed standardized measures preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was Western Ontario McMaster Osteoarthritis Index (WOMAC) pain and function. Three groups were created: depressive symptoms absent (n = 573, 82%), possible depressive symptoms (n = 58, 8%), and probable depressive symptoms (n = 68, 10%) using the Center for Epidemiologic Scale for Depression score. Risk-adjusted analyses examined the association between WOMAC change and the preoperative Center for Epidemiologic Scale for Depression score. After risk adjustment, preoperative possible and probable depressive symptomology was associated with postoperative WOMAC pain scores that were 7.6 and 11.7 points, respectively, worse and WOMAC function scores that were 8.8 and 14.3 points, respectively, worse than those without preoperative depressive symptoms. Depressive symptoms improved postoperatively; by 6 months post-TJA, only 34 (5%) participants screened as having probable depressive symptoms, whereas only 13(2%) had possible depressive symptoms. Postoperative WOMAC pain and function scores improved, but they were negatively affected by possible and probable depressive symptoms. Although depressive symptoms improve postoperatively, preoperative depressive symptoms, especially for those with probable depressive symptomology, may negatively affect postoperative pain and functional recovery even after risk adjustment.

Use of Osteochondral and Meniscal Allografts from Bone Cuts of Total Knee Arthroplasty for the Treatment of Tibial Plateau Malunions: A Case Series of Four Patients Showing Early Results.

Intra-articular malunion of tibial plateau fracture is a complex problem to treat. We are presenting outcomes of our series of patients of malunited tibial plateau fractures treated with osteo-chondro-meniscal allograft from lateral tibial plateau harvested from patients undergoing total knee arthroplasty (TKA). The technique was used in four patients. Preoperative computed tomography (CT) scan was used to match donor and recipient graft dimensions and to measure any malalignment. Patients were evaluated for Visual analogue Scale (VAS) for pain (scale 1-10cm), WOMAC (Western Ontario McMaster Osteo-Arthritis Index) score, knee range of motion, and limb alignment. There were three medial tibial plateau malunions and one lateral tibial plateau malunion. Articular comminution with depression was seen in all of them. One patient underwent concurrent high tibial osteotomy for the elevation of the medial tibial plateau and posterior cruciate ligament reconstruction was performed concurrently in one patient. All patients showed improvement in knee range of motion, WOMAC score, and VAS score for knee pain. Limb alignment improved in all cases. Radiologically there was consolidation of the allograft in all the cases at 6months. The mean follow-up was 15.2months (range 12-18months). Osteochondral allograft can be a good choice for reconstructing large articular cartilage defects in tibial plateau malunions. Osteo-chondro-meniscal grafts obtained during TKA can be a viable alternative for reconstructing such defects with excellent early clinical, functional, and radiological outcomes. IV.

Longitudinal Change in Knee Cartilage Thickness and Function in Subjects with and without MRI-Diagnosed Cartilage Damage.

Cartilage damage diagnosed by magnetic resonance imaging (MRI) is highly prevalent in the population. In this article, we explore whether such cartilage damage is associated with greater longitudinal change in 3D cartilage thickness and knee function in subjects without (risk factors of) knee osteoarthritis. Eighty-two knees of Osteoarthritis Initiative healthy reference cohort participants had baseline and 4-year follow-up MRI and knee function data. Baseline presence of semiquantitatively assessed MRI-based cartilage damage (MOAKS [MRI Osteoarthritis Knee Score] ≥ grade 1.0) was recorded by an experienced radiologist. Longitudinal femorotibial cartilage thickness change was determined after segmentation, using location-independent methodology. Knee function was evaluated by patient-reported outcomes and functional performance measures. Statistical comparisons included analysis of covariance adjusting for age, sex, and body mass index. Forty-five percent of the participants had cartilage damage in at least one femorotibial subregion; the cartilage thickness change score was 15% greater in participants with than in those without damage (1216 ± 434 vs. 1058 ± 277 µm). This difference reached borderline statistical significance with and without adjustment for age, sex, and body mass index (P = 0.05). No significant differences in the change of patient-reported outcomes of knee function (PASE [physical activity score of the elderly] and WOMAC [Western Ontario McMaster Osteoarthritis Index]) or chair stand test results were detected. Of those without femorotibial damage, 58% had cartilage damage in at least one femoropatellar subregion; these had a 9% greater femorotibial cartilage change score than those without femoropatellar or femorotibial damage (difference not statistically significant). In the absence of osteoarthritis risk factors, semiquantitatively assessed MRI-based cartilage damage appears to be associated with greater longitudinal location-independent femorotibial cartilage thickness changes, but not with greater functional deteriorations.

A Study to Assess the Effectiveness of Hydrotherapy on Sensorimotor Functions among Patients with Osteoarthritis in Government Headquarters Hospital at Cheyyar

Background: Osteoarthritis is the most common form of arthritis and the leading cause of pain and physical disability among elderly population. Osteoarthritis is a degenerative joint disorder having a significant economic impact on our health system. Osteoarthritis is known to be most frequent in the lower extremity, especially the knee joint. Objectives: To assess the effectiveness of hydrotherapy on sensorimotor functions among knee osteoarthritis patients. Design: Quasi-experimental design—one-group pretest and posttest—with control group was adopted for the study. Setting: Government Headquarters Hospital at Cheyyar. Participants: Thirty osteoarthritis patients who fulfill the inclusion criteria were selected by purposive sampling. Methods: A pretest was conducted by using modified Western Ontario McMaster Osteoarthritis index scale (WOMAC) for osteoarthritis. Immediately after the pretest, hydrotherapy was given to the patient for 8 weeks and the posttest was conducted to assess the effectiveness of hydrotherapy. Collected data were analyzed by using descriptive and inferential statistics. Results: In pre- and posttest, the paired ‘t’ test value for control group was 3.1 (p &lt; 0.05) and experimental group was 9.3 (p &lt; 0.05). The unpaired ‘t’ test value for control and experimental groups was 6.9 (p &lt; 0.05). This result showed that hydrotherapy was effective in improving the sensorimotor functions of the patients with osteoarthritis. There was a statistically non-significant association found between the posttest scores of the sample and their demographic variables. Conclusion: The findings imply that hydrotherapy is a non-pharmacological, cost-effective and simple intervention without any adverse effects. The results proved that the hydrotherapy was an effective intervention to improve the sensorimotor functions among patients with osteoarthritis.

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.

Mid- to long-term results of modified non-vascularized allogeneic fibula grafting combined with core decompression and bone grafting for early femoral head necrosis

PurposeThe aim of this study was to determine mid-and-long term follow-up results of patients with early femoral head osteonecrosis who were treated by modified free vascularized fibular grafting combined with core decompression and bone grafting.MethodsForty-four patients at early ONFH were included in this study. Visual analog scale (VAS) pain scores, range of hip motion (ROM), and Harris hip score (HHS) were recorded to assess the clinical outcome; Western Ontario McMaster Osteoarthritis index (WOMAC) scores and Short Form 36 health survey (SF-36) were conducted to measure the living quality; X-ray film or magnetic resonance imaging (MRI) was used to evaluate radiographic progression; survivorship was defined as patients did not undergo the total hip arthroplasty (THA) or fusion at the last follow-up. Median follow-up was 7.4 years (6–8.2 years).ResultsThe mean VAS score, ROM, and HHS were significantly improved at the final follow-up compared with preoperative values (p < 0.001). Health assessment including WOMAC scores and SF-36 were also better than those preoperatively (p < 0.001). Seven patients progressed to Ficat III and the four patients progressed to Ficat IV with osteoarthritis. Eight patients who cannot tolerate the pain and had poor living quality underwent THA.ConclusionModified non-vascularized allogeneic fibula Grafting combined with core decompression and bone grafting could improve the clinical outcomes and enhance the quality of life for patients with early ONFH.