WOMAC Function Scores Research Articles

What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial.

Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. Prognostic Level II.

Efficacy of Balneotherapy and Mud Therapy in Patients with Knee Osteoarthritis: A Systematic Literature Review

Abstract Objectives To identify literature reporting on thermal mineral water and mud therapy effectiveness on pain, stiffness and knee function in patients with knee osteoarthritis. Design Systematic evidence scan of MEDLINE and PubMed was performed to identify the randomized controlled trial studies published from 2004 to December 2018. Study selection Papers reporting the effect of balneotherapy and mud therapy for treating knee OA, a duration of ≥2 weeks and in which Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as an outcome measure. Data extraction Not RCT, Studies not in English. Results A quantitative meta-analysis of ten studies (831 patients) was performed. Five clinical studies (407 patients) measured effectiveness of balneotherapy and there was significant difference between the groups in WOMAC pain score, WOMAC stiffness score and WOMAC function score, with the differences in favour of balneotherapy. Six clinical studies (500 patients) measured effectiveness of mud therapy and there was significant difference between the groups in WOMAC pain score, WOMAC stiffness score and WOMAC function score, with the differences in favour of mud therapy. Conclusion This meta-analysis indicates that balneotherapy and mud therapy were clinically effective in relieving pain, stiffness, and improving function, as assessed by WOMAC score.

Intra-Articular Mesenchymal Stromal Cell Injections Are No Different From Placebo in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

To evaluate the efficacy and safety of intra-articular mesenchymal stromal cells (MSCs) injections for knee osteoarthritis (OA) treatment. We performed a systematic literature search in PubMed, Embase, Scopus, and the Cochrane Library through April 2020 to identify level I randomized controlled trials (RCTs) that evaluated the clinical efficacy of MSCs versus control treatments for knee OA. Outcomes were analyzed on an intention-to-treat basis with random-effects models. A total of 13 RCTs were included in the meta-analysis. Compared with placebo, there was no significant difference in VAS for pain (mean difference [MD] 1.62, 95% confidence interval [CI -0.60 to 3.85), WOMAC pain score (MD 1.88, 95% CI -0.21 to 3.98), WOMAC function score (MD -0.67, 95% CI -6.54 to 5.19), or WOMAC stiffness score (MD 0.64, 95% CI -0.86 to 2.14) for MSCs. Moreover, the smallest treatment effect of VAS for pain, WOMAC pain score, WOMAC function score, and WOMAC stiffness score did not exceed the minimum clinically important difference (MCID). Additionally, there was no significant difference in percentage of patients crossing the MCID threshold between MSC and placebo groups for VAS for pain (relative risk [RR] 0.93, 95% CI 0.55 to 1.57) or WOMAC total score (RR 0.40, 95% CI 0.13 to 1.21). Compared with hyaluronic acid (HA), MSC injection was associated with significantly better improvement in VAS for pain (MD 2.00, 95% CI 0.94 to 3.07), WOMAC pain score (MD 4.58, 95% CI 0.49 to 8.67), WOMAC total score (MD 14.86, 95% CI 10.59 to 19.13), and WOMAC stiffness score (MD 1.85, 95% CI 0.02 to 3.69). However, the smallest treatment effect of VAS for pain, WOMAC pain score, WOMAC function score, and WOMAC stiffness score did not exceed the MCID. Moreover, there was no significant difference in percentage of patients crossing the MCID threshold between MSC and HA groups for WOMAC total score (RR 0.57, 95% CI 0.21 to 1.55). We also found that MSCs did not increase adverse events compared with HA and placebo. Intra-articular MSC injection was not found to be superior to placebo in pain relief and functional improvement for patients with symptomatic knee OA. However, additional direct testing and combination trials of different type of cells, doses, and number of injections of MSCs are required to further enhance clinical decision making for people with symptomatic knee OA. I, meta-analysis of level I studies.

The Effects of Vitamin D and Marine Omega-3 Fatty Acid Supplementation on Chronic Knee Pain in Older US Adults: Results From a Randomized Trial.

Knee pain from osteoarthritis is frequent in the adult population. Prior trials have had conflicting results concerning the therapeutic effects of vitamin D on knee pain, and few trials have investigated marine Omega-3 fatty acids (n-3 FA). In the double-blind, placebo-controlled Vitamin D and Omega-3 Trial (VITAL), 25,871 US adults were randomized in a 2-by-2 factorial design to receive vitamin D or n-3 FA. We identified a subgroup with chronic knee pain prior to randomization and assessed knee pain at baseline and annually during follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (graded on a 0-100 scale, where 100 indicates worst symptoms). Repeated measures modeling was used to test the effect of randomized treatment on WOMAC pain scores over follow-up after adjustment for age and sex. Analyses were repeated for WOMAC function and stiffness. This study included 1,398 participants who returned at least one knee pain questionnaire. The mean age was 67.7 years, 66% were women, and the mean ± SD WOMAC pain score was 37 ± 19. The mean ± SD follow-up time was 5.3 ± 0.7 years. WOMAC pain did not differ between the active vitamin D group and the vitamin D placebo group or between the active n-3 FA group and the n-3 FA placebo group at any time point during follow-up. Linear time-by-treatment interactions were not significant for either treatment (vitamin D, P = 0.41; n-3 FA, P = 0.77). Vitamin D and n-3 FA supplementation did not significantly affect WOMAC function or stiffness scores over time. Our findings indicate that vitamin D and n-3 FA supplementation for a mean of 5.3 years does not reduce knee pain or improve function or stiffness in a large sample of US adults with chronic knee pain.

Psychosocial Determinants of Total Knee Arthroplasty Outcomes Two Years After Surgery.

ObjectiveTo evaluate the association of preoperative psychosocial and demographic factors with total knee arthroplasty (TKA) outcomes and satisfaction in patients with osteoarthritis (OA) of the knee at 24 months after surgery.MethodsA prospective cohort study of patients undergoing TKA was conducted. Outcome measures included: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 (SF‐36) scores at baseline and 24 months after surgery, and patient satisfaction with TKA at 24 months. Linear regression models were performed to evaluate the association of preoperative psychosocial determinants (ie, Medical Outcome Study Social Support Scale; Depression, Anxiety, and Stress Scale; Brief COPE inventory, The Life Orientation Test‐Revised; Multidimensional Health Locus of Control; and Arthritis Self‐Efficacy Scale) on outcomes.ResultsWe included 178 patients. Increasing WOMAC pain scores at 24 months were associated with increasing age and body mass index (BMI); low tangible social support and low optimism were associated with higher levels of pain (R 2 = 0.15). A decrease in WOMAC function scores was also associated with older age and higher BMI; low tangible support, increased stress, and low optimism were also associated with worse function (R 2 = 0.22). When evaluating quality of life, lower SF‐36 physical functioning scores at 24 months were associated with age, high BMI, and comorbidity (R 2 = 0.34). Lower SF‐36 mental functioning scores were associated with depression and low optimism (R 2 = 0.38). Having a dysfunctional style of coping was associated with lower satisfaction with surgery after 24 months (adjusted R 2 = 0.12).ConclusionPsychosocial factors, such as tangible support, depression, dysfunctional coping, and optimism, were associated with pain, function, and satisfaction 2 years after TKA. Perioperative programs identifying and addressing psychosocial problems may result in improvements in pain and function after TKA.

The effects of kinesiophobia on outcome following total knee replacement: a systematic review.

Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. A primary search of electronic databases, grey literature, and trial registries was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Outcome measures were grouped into short (< 6months), medium (6-12months), and long term (> 12months). Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials. All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12months in three studies (r = 0.20 p < 0.05, R = 0.317 p = 0.001, and correlation coefficient 0.197 p = 0.005). TSK score significantly correlated with mean active range of motion (ROM) at 2weeks [65.98 (SD = 14.51) versus 47.35 (SD = 14.48) p = 0.000], 4weeks [88.20 (SD = 15.11) versus 57.65 (SD = 14.80) p = 0.000], and 6months [105.33 (SD = 12.34) versus 85.53 (SD = 14.77) p = 0.000] post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme [TSK -14.30 (SD = 0.80) versus -2.10 (SD = 0.80) p < 0.001], an outpatient cognitive behavioural therapy (CBT) programme [TSK 27.76 (SD = 4.56) versus 36.54 (SD = 3.58)], and video-based psychological treatment [TSK 24 (SD = 5) versus 29 (SD = 5) p < 0.01]. Kinesiophobia negatively affects functional outcomes up until 1year post-operatively, while active ROM is reduced up to 6months post-procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.

Gonartrozlu Yaşlı Hastada D Vitamininin Kas Gücü ve Fonksiyonel Durum Üzerine Etkisi

Introductıon: The aim of this study was to evaluate the effects of vitamin D levels on pain intensity, muscle strength and functional status of elderly patients with osteoarthritis of the knee. &#x0D; Methods: Eighty one patients with osteoarthritis of the knee were enrolled in this study. The pain was measured with visual analogue scale (VAS). Western Ontario and McMaster University Arthritis Index (WOMAC) was used to evaluate pain, stiffness, and physical function. The maximum isokinetic muscle strength and the peak torque/body weight values were measured. &#x0D; Results: The patients were divided into two groups according to their 25 (OH) vitamin D levels: Group 1 consisted of patients whose 25 (OH) vitamin D levels were below 20 ng/ml and Group 2 comprised those with levels above 20 ng/ml. The VAS scores, the mean WOMAC pain, function and total scores were higher in Group 1 than Group 2. The maximal isokinetic muscle strength of extensor and flexor muscles of the knee and the peak torque/body weight values were significantly lower in Group 1 than in Group 2 (p

Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported Outcomes After Medial Opening Wedge High Tibial Osteotomy

Background: Although the medial compartment continues to sustain some loading after medial opening wedge high tibial osteotomy (MOWHTO) in varus-deformed knees, no studies have examined the relationship between medial meniscal extrusion (MME) and patient-reported outcome measures after MOWHTO. Purpose: To examine whether compartmental baseline MME was associated with patient-reported outcome measures after MOWHTO. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study was composed of 149 MOWHTOs in 147 patients with clinical and radiological assessments. Patients were grouped according to severity of MME in the medial compartment at the time of surgery. MME was categorized into 4 groups according to MOAKS (MRI [magnetic resonance imaging] Osteoarthritis Knee Score) criteria and relative value of MME. We compared preoperative characteristics, including Kellgren-Lawrence (KL) grading scale, meniscal tear pattern, and postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores. Associations between extent of MME and WOMAC subscores at postoperative 1 and 2 years were assessed with generalized linear models. Results: Pattern of meniscal tear (P < .05) and KL grade (P < .05) were associated with MME. Patients with KL grades 3 and 4 at the time of surgery had significantly greater MME than those with KL grade 2 (P < .05). When patients were divided into 4 groups according to MOAKS criteria at the time of surgery, there were significant differences in WOMAC pain scores among groups at 1 and 2 years after the operation (all P < .05). The WOMAC function score also differed among groups at postoperative 1 year (P < .05) but not postoperative 2 years (P > .05). When patients were divided into 4 groups according to relative MME at the time surgery, the WOMAC pain score differed significantly among groups at postoperative 1 and 2 years (all P < .05). Analysis of WOMAC pain score as the dependent variable in multivariate analyses revealed that severity of absolute and relative MME and KL grade were independent predictors of worse WOMAC pain score at postoperative 1 and 2 years (all P < .05). Conclusion: Greater preoperative MME at the time of surgery was associated with inferior patient-reported outcomes, especially pain, in patients with MOWHTO at 1 and 2 years after surgery.

Minimal important differences for the WOMAC osteoarthritis index and the Forgotten Joint Score-12 in total knee arthroplasty patients

BackgroundTotal knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. Patient reported-outcome measures (PROMs) capture the patients’ perception of the success of an intervention. The minimal important difference (MID) is an important characteristic of the PROM, which helps to interpret results. The aim of this study was to identify the MID for the Forgotten Joint Score-12 (FJS-12) and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index.MethodsData were collected in a prospective cohort study. Patients were asked to complete the FJS-12, WOMAC osteoarthritis index and transition items evaluating change over time to determine the MID. We employed an anchor-based methodology relating score change to the response categories of the transition items using both binary logistic regression and receiver operating characteristic (ROC) analysis.ResultsData from 199 patients were analysed. Mean age was 72.3 years, 58% were women. Employing binary logistic regression the MID for the FJS-12 was 10.8 points, for the WOMAC pain score 7.5 points and for the WOMAC function score 7.2 points. ROC analyses found a MID of 13.0 points for the FJS-12, 12.5 points for WOMAC pain and 14.7 points for WOMAC function.ConclusionWe report MIDs for the FJS-12 and the WOMAC Pain and Function scales in a TKA patient cohort, which can be used to interpret meaningful differences in score. In line with previous research, we found more advanced statistical methods to result in smaller MID estimates for both scores.Trial registrationWritten consent for this study was obtained from all participants and ethical approval was granted by the local ethics committee (Ethikkommission St. Gallen; EKSG 14/973; Registered 03 July 2014; http://www.sg.ch/home/gesundheit/ethikkommission.html).

Changes in knee adduction moment wearing a variable-stiffness shoe correlate with changes in pain and mechanically stimulated cartilage oligomeric matrix levels.

This study aimed to determine if changes in knee adduction moment (KAM) after 6 months of variable-stiffness shoe wear are associated with changes in symptoms or serum levels of cartilage oligomeric matrix protein (COMP) following a mechanical stimulus in subjects with medial knee osteoarthritis (OA). Twenty-five subjects were enrolled in the study and assigned a variable-stiffness shoe, and 19 subjects completed the 6-month follow-up. At baseline and follow-up subjects underwent gait analysis in control and variable-stiffness shoes, completed Western Ontario and McMaster Universities (WOMAC) questionnaires, and serum COMP concentrations were measured immediately before, 3.5 and 5.5 hours after a 30-minute walking activity. Relationships between changes in KAM (first peak and impulse) and changes in (a) COMP levels in response to the 30-minute walking activity and (b) WOMAC scores from baseline to 6-month follow-up were assessed by Pearson correlation coefficients. Changes in first peak KAM were associated with changes in COMP levels 5.5 hours postactivity from baseline to follow-up (R = .564, P = .045). Subjects with greater reductions in KAM had larger decreases in COMP (expressed as a percent of preactivity levels) at follow-up. Subjects with greater reductions in KAM impulse had significantly greater improvements in WOMAC Pain (R = -.56, P = .015) and Function (R = -.52, P = .028) scores at follow-up. The study results demonstrated the magnitude of reduction in the KAM wearing a variable-stiffness shoe is associated with decreases in mechanically stimulated COMP levels and pain/function. This work suggests that interactions between COMP and joint loading during walking should be further investigated in future studies of treatment outcomes in OA.

Osteoarthritis physical activity care pathway (OA-PCP): results of a feasibility trial

BackgroundTo obtain information on feasibility and acceptability, as well as preliminary data on efficacy, of an Osteoarthritis Physical activity Care Pathway (OA-PCP).MethodsThis was a single group pilot study involving 60 participants with symptomatic, physician diagnosed knee or hip OA, recruited from primary care clinics. Participants self-reported completing less than 150 min per week of moderate-to-vigorous physical activity (MVPA) at baseline. The 3-month OA-PCP intervention involved 3 physical activity (PA) coaching calls (focused on goal setting), three check-in emails and linkage with community-based or online resources to support PA. Efficacy outcomes were collected at baseline and 4-month follow-up. The primary efficacy outcome was minutes of MVPA, assessed via accelerometer. Secondary outcomes included minutes of light intensity activity, sedentary minutes, step counts, and Western Ontario and McMaster Universities (WOMAC) pain and function subscales. Participants were also asked to rate the helpfulness of the OA-PCP intervention on a scale of 0–10. Differences in efficacy outcomes between baseline and 4-month follow-up were assessed using paired t-tests.ResultsAmong participants beginning the study, 88% completed follow-up assessments and ≥ 90% completed each of the intervention calls. Average daily minutes of MVPA was 8.0 at baseline (standard deviation (SD) = 9.9) and 8.9 at follow-up (SD = 12.1, p = 0.515). There were no statistically significant changes in light intensity activity, sedentary time or step counts. The mean WOMAC pain score improved from 8.1 (SD = 3.6) at baseline to 6.2 (SD = 3.8) at follow-up (p < 0.001); the mean WOMAC function score improved from 26.2 (SD = 13.2) to 20.2 (SD = 12.5; p < 0.001). The mean rating of helpfulness was 7.6 (SD = 2.5).ConclusionsResults supported the feasibility and acceptability of the study, and participants reported clinically relevant improvements in pain and function. PA metrics did not improve substantially. Based on these results and participant feedback, modifications including enhanced self-monitoring are being made to increase the impact of the OA-PCP intervention on PA behavior.Trial registrationNCT03780400, December 19, 2018.

Mid-term results of a prospective randomised controlled trial comparing large-head metal-on-metal hip replacement to hip resurfacing using patient-reported outcome measures and objective functional task-based outcomes.

The early outcomes of large head-metal-on-metal total hip arthroplasty (MoM THA) are compromised by adverse local tissue reaction to metal debris. This study is the mid-term follow-up of a prospective randomised control trial (pRCT) comparing MoM THA to MoM HR. We sought to answer whether there was a difference between MoM THA and MoM HR at mid-term follow-up in the implant survival; patient-reported outcome measures (PROMs); and when performing objective functional tasks? A total of 104 patients were studied. Of these 56 had MoM THA (50 male) and 48 had HR (43 male). Mean age at surgery was 52 years in both groups.We reviewed this cohort at mid-term follow-up [minimum 8 years (mean 9 years; range 8-10; SD 0.7)]. PROMs that were completed were OHS, WOMAC, SF-12, and the UCLA. For objective functional task-based outcomes, gait parameters for operated legs were assessed in a subgroup of 17 patients with high UCLA. Revision rate in MoM THA group was 7/56 (12.5%) and in the HR group was 1/48 (2.1%). Overall revision rate at minimum 8-year follow-up was 7.7% (8 of 104 patients). PROMs data comparing MoM THA versus HR showed no difference between the groups. 4 (8.5%) of the non-revised (47) HR patients had WOMAC function or pain score below 70. 3 (6.4%) patients had both pain and function scores <70. In the THA group, 5 (10.2%) of the non-revised (49) patients had WOMAC pain or function scores <70. 3 (6.1%) patients had both pain and function scores <70. The comparison of HA versus THA showed several gait parameters in the HR group to be better but not statistically significant (p > 0.05 Mann-Whitney U-test). At mid-term follow-up, the revision rate of MoM articulation for THA is high (7.7%), being higher in large head MoM total hips versus resurfacing. Overall probability of 10-year survival is 92.3% (KM analysis, 95% for MoM THA and 98% for HR). The HR group had better functional parameters on gait-based tasks compared to THA group but this difference did not reach statistical significance.

Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial.

To test the efficacy of intra-articular hypertonic dextrose prolotherapy (DPT) vs normal saline (NS) injection for knee osteoarthritis (KOA). A single-center, parallel-group, blinded, randomized controlled trial was conducted at a university primary care clinic in Hong Kong. Patients with KOA (n = 76) were randomly allocated (1:1) to DPT or NS groups for injections at weeks 0, 4, 8, and 16. The primary outcome was the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 0-100 points) pain score. The secondary outcomes were the WOMAC composite, function and stiffness scores; objectively assessed physical function test results; visual analogue scale (VAS) for knee pain; and EuroQol-5D score. All outcomes were evaluated at baseline and at 16, 26, and 52 weeks using linear mixed model. Randomization produced similar groups. The WOMAC pain score at 52 weeks showed a difference-in-difference estimate of -10.34 (95% CI, -19.20 to -1.49, P = 0.022) points. A similar favorable effect was shown on the difference-in-difference estimate on WOMAC function score of -9.55 (95% CI, -17.72 to -1.39, P = 0.022), WOMAC composite score of -9.65 (95% CI, -17.77 to -1.53, P = 0.020), VAS pain intensity score of -10.98 (95% CI, -21.36 to -0.61, P = 0.038), and EuroQol-5D VAS score of 8.64 (95% CI, 1.36 to 5.92, P = 0.020). No adverse events were reported. Intra-articular dextrose prolotherapy injections reduced pain, improved function and quality of life in patients with KOA compared with blinded saline injections. The procedure is straightforward and safe; the adherence and satisfaction were high.

Comparison of the short-term results of single-dose intra-articular peptide with hyaluronic acid and platelet-rich plasma injections in knee osteoarthritis: a randomized study

Introduction/objectivesIntra-articular injections may be useful in terms of pain and functional status, in knee osteoarthritis (OA). Besides hyaluronic acid (HA) and platelet-rich plasma (PRP), peptide molecules recently begin to be used. The aim of this study was to compare the efficacy of intra-articular peptide Prostrolane® (CAREGEN Co. Ltd.) injection with that of the HA and PRP in the persons with OA.MethodFifty-four patients with OA were included in this prospective, randomized study. Patients were randomized into three groups as intra-articular HA, peptide, and PRP groups. Paracetamol was permitted three times a day to all groups. All the patients were evaluated by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Health Assessment Questionnaire (HAQ), and visual analogue scale (VAS) at rest and during movements. Measurements performed at the baseline, after the first week of injection, and at the first and third months of follow-up.ResultsMean age was 55.8 ± 8.9 years. Forty-four (81.6%) were women. A week after the injections, rest and movement pain severity was measured by VAS decreased significantly in all the study groups (p < 0.05). There were no statistically significant differences between the groups in terms of first week pain relief (p > 0.05). WOMAC pain, stiffness, function, and total scores were improved significantly in all the groups a week after the injections (p < 0.05). Improvement continued at the third month control; however, the improvement in the WOMAC pain score was significantly better in the peptide group at the third month control (p < 0.05). The decrease in the rest and movement pain was continued for 3 months except the HA group’s rest pain. There were no differences among the groups for all measurements, except for the WOMAC pain score at 3 months after treatment, which was significantly lower in the peptide group.ConclusionAs a result, pain relief and functional improvement were obtained after the intra-articular HA, peptide, and PRP injections in OA, and decrease in pain was better in the peptide group.Key Points• The short-term effects of intra-articular HA, peptide, and PRP injections were compared in knee osteoarthritis.• HA, peptide, and PRP injections may be useful in pain relief and functional improvement in knee osteoarthritis.

The Role of PRP and Its Platelet Concentration in Improving WOMAC Score on Early-Stage Knee Osteoarthritis (OA) Patients

Platelet concentration is one of the important factors in OA treatment with platelet-rich plasma (PRP). The purpose of this study was to determine the effect of PRP quality, which was determined by its platelet concentration, on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in early-stage knee OA patients. This study involved 50 patients diagnosed with early-stage knee OA (stage I to III). Twenty-five patients received PRP with moderate platelet concentration (1× to 4×), another twenty-five patients received PRP with high platelet concentration (>4× to 6×). Patients were evaluated using WOMAC questionnaire before and three months after injection with PRP. Bivariate analysis showed that there was a significant improvement of three WOMAC score subscales (pain, stiffness, and function) in both group (p<0.05) and a significant difference in the differences between WOMAC pain scores between the two groups (p<0.05), meanwhile, significant differences in the differences between WOMAC stiffness and function scores between the two groups weren’t found (p>0.05). The conclusions of this study was, PRP with moderate and high platelet concentration had been shown to improve the three WOMAC score subscales of early-stage knee OA patients, but the effect of PRP’s platelet concentration was only significant in the improvement of WOMAC pain score.

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

BackgroundStudies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA.MethodsThe PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation.ResultsSeven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: − 0.31; 95% confidence interval (CI): − 0.55 to − 0.06; P = 0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: − 0.54 to − 0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P > 0.05).ConclusionsCompared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone.

A prospective study of persistent postsurgical pain at 1 year after total knee arthroplasty in a Japanese tertiary hospital

Purpose: Total knee arthroplasty (TKA) is one of the most common and successful orthopaedic surgeries performed throughout the world. Although good pain relief can be achieved with TKA, significant proportion of patients experience persistent postsurgical pain (PPSP). A systematic review of recent studies from Europe and United States showed that 10-34% of patients complain of PPSP. However, since no prospective studies have ever been conducted in Japan, the prevalence of PPSP in the Japanese population is unknown. The aim of this prospective study was to elucidate the prevalence and preoperative risk factors of PPSP after TKA in a Japanese tertiary hospital. Methods: Between April 2012 to March 2018, patients were recruited in a Japanese tertiary hospital. Four hundred twenty-six TKAs were performed in patients during the period. Two hundred eighty-eight patients underwent unilateral TKA while 30 patients underwent simultaneous bilateral TKA. Preoperative diagnosis was osteoarthritis in 394 knees, rheumatoid arthritis in 28 knees, and osteonecrosis in 4 knees. Exclusion criteria were as follows: dementia, symptomatic venous thrombosis, periprosthetic join infection, and mal-positioned TKA (≧3 degrees error in sagittal and/or coronal plane). Preoperative evaluation included pain visual analog scale (VAS) at rest and at walk, WOMAC, Knee Society Score (KSS), EQ-5D, pain catastrophizing scale, pain DETECT. All TKA were performed under both general anesthesia and ultrasound-guided femoral nerve block. Postoperative pain was evaluated using a 100mm VAS. Patients were instructed to express their pain around the replaced knee while rest and walking during the past week by putting a mark on the 100mm VAS by themselves. PPSP was defined as a VAS score of >30 while walking at 1 year follow up. The prevalence of PPSP was calculated from patients followed at 1 year after surgery. The preoperative risk factors for PPSP were analyzed from patients who completed preoperative questionnaires. Statistical comparison between with and without PPSP was analyzed by Mann-Whitney U test and Chi-squared test. To determine the risk factors for PPSP, logistic regression analysis was used from among those factors which had significant difference (p<0.05) in univariate analysis. Results: Of 318 patients who underwent TKA, 346 knees of 254 patients were followed at 1 year after surgery. The prevalence of PPSP was 8.4% (19 of 346 knees). Two hundred and forty-six knees of 190 patients completed preoperative questionnaires. The mean age at surgery was 74 years old (range 43-90). Univariate analysis showed that patients with PPSP had significantly higher VAS at rest, WOMAC pain score, WOMAC stiffness score, WOMAC function score, WOMAC total score and lower EQ-5D compared with those without. Logistic regression analysis showed that WOMAC function score significantly affected PPSP (odds ratio = 1.078, 95% confidence interval 1.035-1.123). Conclusions: The rate of persistent pain was 8.4%. This result is lower than past reports from Europe and United States. In our department, surgeons basically take postoperative follow by themselves at 6 weeks, 3, 6, 12 months after surgery and every year. When we find patients who have something wrong around the replaced knee, we diagnose what is going on and treat appropriately. For example, we treated with steroid injection for infrapatellar saphenous neuralgia and pregabalin medication for lumber radiculopathy at some point. Recent studies have found that PPSP is associated with preoperative knee pain, younger patient, catastrophizing and mental health, while our findings showed the predictive factor of PPSP was WOMAC function score. This is the first report of prospective study for PPSP after TKA in Japan.Table 1.Comparison between patients with and without PPSP.PPSP (-) n=224 kneesPPSP (+) n=22 kneesP valueAge at surgery (years)73 [68-79]76 [72.5-79]0.116Sex (men/women)52 / 1723 / 190.304VAS at rest (mm)20 [5-40]30 [11.3-70]0.045VAS at walk (mm)20 [50-80]70 [54.8-80]0.295WOMAC pain9 [7-11]12 [10-13]0.001WOMAC stiffness5 [4-6]6 [4.3-6]0.036WOMAC function29 [20-39]41 [36.5-49]<0.001WOMAC total44 [32-56]60.5 [52.3-67.3]<0.001KSS knee score50 [39-61]50 [45-60]0.074KSS function score50 [45-60]45 [45-60]0.999EQ-5D0.631 [0.536-0.649]0.562 [0.495-0.596]0.002PCS27 [18.5-32]29.5 [18.8-33]0.243painDETECT10 [6-14]8 [7-16.5]0.946Data are median [IQR]. Statistical comparison between with and without PPSP was analyzed by Mann-Whitney U test and Chi-squared test. Open table in a new tab Data are median [IQR]. Statistical comparison between with and without PPSP was analyzed by Mann-Whitney U test and Chi-squared test.

Longitudinal changes in specific muscle strength but not in muscle anatomical cross-sectional areas is associated with change in knee function - data from the osteoarthritis initiative (OAI)

Purpose: A positive and concurrent association between longitudinal change in knee function (worsening or improvement ≥6 [minimal clinically important difference (MCID)] on the WOMAC function score during Y2→Y4) and change in isometric extensor muscle strength was previously reported. Although muscle anatomical cross-sectional areas (ACSAs) or muscle mass have been shown to be moderately related to muscle strength, it is unknown whether function-related change in muscle strength depends on concordant change in ACSAs or specific strength (e.g.

Effect of atorvastatin on knee structure and pain in patients with knee osteoarthritis: a randomised controlled trial

Purpose: Observational studies have shown an effect of oral statin on reducing structural progression of knee osteoarthritis. However, no randomised controlled trials have been performed. This study examined the effect of atorvastatin compared to placebo on reducing structural progression and improving symptoms in participants with symptomatic knee osteoarthritis. Methods: A multicentre, randomised, parallel-group, double-blind, placebo-controlled trial was conducted in Melbourne, Hobart, and Adelaide, Australia. Participants aged 40-70 years with symptomatic knee osteoarthritis assessed by the American College of Rheumatology criteria were randomly assigned in a 1:1 ratio to receive oral atorvastatin 40 mg (n=151) or inactive matching placebo (n=153) once daily over two years. The primary outcome was annual percentage change in tibial cartilage volume assessed using magnetic resonance imaging (MRI) over two years. Secondary outcomes were worsening of tibiofemoral cartilage defects and bone marrow lesions (BMLs) assessed using MRI and change in knee pain and function assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) over two years. Intention-to-treat analyses were performed. Analysis of intervention effects according to the absence or presence of BMLs at baseline was pre-specified. Results: Of 304 participants (mean age 55.7 years, 55.6% female), 248 (81.6%) completed the trial. Annual change in tibial cartilage volume was not significantly different between groups [atorvastatin: -0.26% (95% CI -0.92% to 0.41%) vs. placebo: -0.91% (95% CI -1.52% to -0.30%), p=0.15]. No significant between-group differences were observed in worsening of cartilage defects (atorvastatin: 59.6% vs. placebo: 63.4%, p=0.56) or BMLs (57.6% vs. 57.5%, p=0.99), or change in WOMAC pain (-35.9 vs. -31.6, p=0.78) or function score (-90.7 vs. -92.8, p=0.97). In those without BMLs at baseline (n=105), annual change in tibial cartilage volume was significantly different between the atorvastatin and placebo groups [0.50% (95% CI -0.88% to 1.87%) vs. -1.19% (95% CI -2.09% to -0.30%)] where significant cartilage volume loss was observed in the placebo group but not in the atorvastatin group with a between-group difference of -1.69% (95% CI -3.36% to -0.02%, p=0.047) (Table 1). There were no significant differences in adverse events between groups. Conclusions: Among participants with symptomatic knee osteoarthritis, oral atorvastatin 40 mg once daily did not reduce knee cartilage loss or knee pain over two years. However, atorvastatin reduced cartilage loss in those without BMLs, suggesting atorvastatin may have a disease-modifying effect in those with knee osteoarthritis and without BMLs.Table 1Change in cartilage volume, cartilage defects, bone marrow lesions, knee pain and functionWithin-group change, mean (95% CI)Between-group difference Atorvastatin - PlaceboP for interaction between BMLs and treatmentAtorvastatin (n=151)Placebo (n=153)Mean difference (95% CI)PAnnual % change in tibial cartilage volume-0.26 (-0.92 to 0.41)-0.91 (-1.52 to -0.30)0.66 (-0.24 to 1.55)0.15Without BMLs0.50 (-0.88, 1.87)-1.19 (-2.09, -0.30)-1.69 (-3.36, -0.02)0.0470.11With BMLs-0.61 (-1.37, 0.16)-0.75 (-1.54, 0.04)-0.14 (-1.19, 0.91)0.79Change in WOMAC pain (0-500)-35.9 (-60.1 to -11.7)-31.6 (-49.2 to -14.0)-4.3 (-34.9 to 26.4)0.78Without BMLs-36.0 (-84.1, 12.2)-26.9 (-59.0, 5.1)-9.0 (-69.4, 51.4)0.760.83With BMLs-35.9 (-62.6, -9.1)-34.4 (-56.2, -12.6)-1.4 (-36.4, 33.5)0.94Change in WOMAC function (0-1700)-90.7 (-169.5 to -11.9)-92.8 (-152.3 to -33.4)2.1 (-99.7 to 103.9)0.97Without BMLs-80.3 (-234.5, 73.8)-58.8 (-168.7, 51.1)-21.5 (-226.1, 183.0)0.830.74With BMLs-95.6 (-182.9, -8.2)-113.0 (-185.4, -40.7)17.4 (-97.5, 132.4)0.77No (%)No (%)Odds ratio (95% CI)Atorvastatin vs. PlaceboPP for interaction between BMLs and treatmentWorsening of cartilage defects90 (59.6)97 (63.4)0.86 (0.51, 1.44)0.56Without BMLs25 (52.1)34 (59.6)0.72 (0.30, 1.69)0.440.64With BMLs65 (63.1)63 (65.6)0.92 (0.49, 1.72)0.79Worsening of BMLs87 (57.6)88 (57.5)1.00 (0.62, 1.63)0.99Without BMLs18 (37.5)30 (52.6)0.50 (0.20, 1.29)0.150.09With BMLs70 (68.0)58 (60.4)1.38 (0.74, 2.55)0.31 Open table in a new tab

The PAT randomized clinical trial.

A pragmatic, single-centre, double-blind randomized clinical trial was conducted in a NHS teaching hospital to evaluate whether there is a difference in functional knee scores, quality-of-life outcome assessments, and complications at one-year after intervention between total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA) in patients with severe isolated patellofemoral arthritis. This parallel, two-arm, superiority trial was powered at 80%, and involved 64 patients with severe isolated patellofemoral arthritis. The primary outcome measure was the functional section of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months. Secondary outcomes were the full 24-item WOMAC, Oxford Knee Score (OKS), American Knee Society Score (AKSS), EuroQol five dimension (EQ-5D) quality-of-life score, the University of California, Los Angeles (UCLA) Physical Activity Rating Scale, and complication rates collected at three, six, and 12 months. For longer-term follow-up, OKS, EQ-5D, and self-reported satisfaction score were collected at 24 and 60 months. Among 64 patients who were randomized, five patients did not receive the allocated intervention, three withdrew, and one declined the intervention. There were no statistically significant differences in the patients' WOMAC function score at 12 months (adjusted mean difference, -1.2 (95% confidence interval -9.19 to 6.80); p = 0.765). There were no clinically significant differences in the secondary outcomes. Complication rates were comparable (superficial surgical site infections, four in the PFA group versus five in the TKA group). There were no statistically significant differences in the patients' OKS score at 24 and 60 months or self-reported satisfaction score or pain-free years. Among patients with severe isolated patellofemoral arthritis, this study found similar functional outcome at 12 months and mid-term in the use of PFA compared with TKA. Cite this article: Bone Joint J 2020;102-B(3):310-318.