WOMAC Function Research Articles

Efficacy, safety and tolerability of GSK3858279, an anti-CCL17 monoclonal antibody and analgesic, in healthy volunteers and patients with knee osteoarthritis pain: a phase I, randomised, double-blind, placebo-controlled, proof-of-mechanism and proof-of-concept study

ObjectivesThe objective of this study was to evaluate efficacy, safety and tolerability of the first-in-class, anti-CCL17 monoclonal antibody, GSK3858279, in treating knee osteoarthritis (OA) pain.MethodsThis was a phase I, randomised,...

Disparities between rural and urban communities: Response to 18-months of diet and exercise versus control for knee osteoarthritis and overweight or obesity.

The study objective was to determine whether the clinical response of older adults with knee osteoarthritis and overweight or obesity to 18 months of diet and exercise or attention control interventions differed between participants from rural versus urban communities. Participants were 823 older adults (mean age, 64.6 years; 77% women) with knee osteoarthritis, overweight or obesity, who resided in rural (N = 410) and urban (N = 413) counties in North Carolina. All were enrolled in the WE-CAN clinical trial that randomly assigned participants to either 18-months of diet and exercise (D+E) or attention control (C) interventions. General linear models were used to examine differences in clinical outcomes between rural and urban groups after adjusting for covariates. The rural group had significant differences (P<.05) at baseline in clinical outcomes, education, comorbidities, medication use, and income compared to the urban dwellers. After adjusting for baseline differences, the group (rural, urban) by treatment (D+E, C) interactions for WOMAC pain (rural: D+E-C= -0.63,95%CI,-1.31 to 0.06; urban: D+E-C= -0.29,95%CI,-0.99 to 0.41;P=.50) and WOMAC function (rural: D+E-C = -4.60,95%CI,-6.89 to -2.31; urban: D+E-C = -1.38,95%CI,-3.73 to 0.94;P=.054) indicated that the groups responded similarly to the interventions. Among participants with knee osteoarthritis and overweight or obesity, diet and exercise compared to attention control led to similar pain outcomes in rural and urban dwellers that favored diet and exercise; the possibility there may be greater differential efficacy in functional outcomes among rural participants needs further study.

Quantitative analysis of effectiveness and associated factors of exercise on symptoms in osteoarthritis: a pharmacodynamic model-based meta-analysis

ObjectiveThis study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors...

Effects of group-based versus individual physical exercise programs for knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is the most common joint disease worldwide and is associated with a high rate of disability and poor quality of life. However, little is known about the therapeutic effects of group-based versus individual-based physical exercise protocols. Objective: To investigate the effects of individual versus group-based physical exercises on pain intensity and functional outcomes in people with knee OA. Methods: MEDLINE/PubMed, Cochrane, EMBASE, and PEDro databases were searched from the earliest date available to July 2023. Study quality was evaluated using the PEDro scale. Mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated using a random effect model. Results: Six studies, with 763 patients, met the study criteria. Group-based physical exercises improved pain intensity (VAS 0-100) MD -17.2 (95% CI: -22.2 to -12.3), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale MD -0.54 (95% CI: -1.0 to -0.08), WOMAC function subscale MD -2.1 (95% CI: -4.1 to -0.08) compared to individual modality. No significant difference regarding muscle strength and exercise tolerance was found for participants in the group-based physical exercises compared with individual physical ones. Conclusion: Group-based physical exercise was more successful in reducing pain intensity and functional impairment in patients with knee OA than individual exercise programs. Both group-based and individual physical exercise programs enhanced muscle strength and 6-minute walk distance.

Curative Effect of Electroacupuncture and Manual Acupuncture for Knee Osteoarthritis: A Meta-Analysis.

We aimed to examine how electroacupuncture and manual acupuncture affect treatment results, pain levels, and joint function in individuals with knee osteoarthritis. Research was carried out in various databases including PubMed, Medline, Embase, CENTRAL, and CNKI. Following the "Cochrane manual", the risk of bias of included RCTs was assessed. A funnel plot was utilized to evaluate any potential bias in the publications. The impact size was indicated by the average discrepancy along with its 95% confidence interval. The EA group showed a higher effectiveness rate (P = 0.001) and a lower WOMAC pain score (P < 0.00001) compared to the control group. The EA group had a lower WOMAC pain score compared to the SA/exercise group and the group that received manual acupuncture. The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group under intense electroacupuncture stimulation (P < 0.0001). The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group when weak current acupuncture was applied (P = 0.0001). However, no significant difference in WOMAC function score between EA and control group. Comparison to manual acupuncture, placebo acupuncture, and exercise training, electroacupuncture enhanced the effectiveness of treating KOA and decreased the WOMAC pain score in patients with KOA. The level of pain relief achieved may be linked to the strength of the current stimulation. However, electroacupuncture had no significant effect on WOMAC function score.

A study of the Effects of Physiotherapy on Knee Osteoarthritis

Osteoarthritis (OA) of the knee is a common chronic illness that causes pain and limited movement, greatly reducing quality of life. To manage knee OA, this randomised controlled trial evaluated the effectiveness of a comprehensive physiotherapy program that included exercise treatment, manual therapy, and patient education. One hundred individuals with moderate to severe osteoarthritis (OA) were randomised to be in one of two groups: the intervention group or the control group, which received conventional care. Supervised exercises, manual joint mobilisations, soft tissue manipulations, and education sessions on disease management and lifestyle adjustments were all part of the 12-week intervention. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to measure pain and physical function as primary objectives. The Short Form-36 (SF-36) health survey was used to measure knee range of motion, muscle strength, and quality of life as secondary goals. The intervention group significantly outperformed the control group in terms of knee range of motion, muscle strength, and WOMAC pain and function scores (p &lt; 0.001), according to the results. Furthermore, the intervention group's quality of life scores in the domains of pain and physical functioning were significantly higher. These results, which are in line with other research emphasizing the importance of exercise, manual treatment, and patient education in improving clinical outcomes, demonstrate the many advantages of a physiotherapy program in the effective management of knee OA. This study supports the integration of comprehensive physiotherapy into standard knee OA treatment protocols to improve patient well-being and functional capabilities. Future research should focus on optimizing these interventions for broader clinical application.

The Effects of Peloid and Balneotherapy on Arthritis: A Systematic Review

Background: Over the decades, the prevalence of arthritis in the United States has skyrocketed. Arthritis is the most common cause of disability in the United States. According to the National Arthritis Data Workgroup, more than 22% of American adults (which is equivalent to over 52.5 million people) suffer from arthritis or a rheumatic condition. Of those diagnosed with arthritis, 7.3% of people are aged 18-44, 30.3% are 45-64 years old, and 49.7% are over the age of 65. Women are also more prone to developing this disease than men; 26% of women have been diagnosed with arthritis whereas 19.1% of men have been diagnosed with arthritis. Researchers estimated that by 2030, the number of people who will be diagnosed with arthritis will increase to 67 million. There are three most common types of arthritis, two of which will be the focus of this systematic literature review, these include osteoarthritis and rheumatoid arthritis. Osteoarthritis is characterized by degeneration of cartilage as well as bony overgrowth while rheumatoid arthritis, while rheumatoid arthritis is an autoimmune and inflammatory disease affecting the joints of the body. Peloid and balneotherapy dates to the ancient past. Humans searching for healing remedies in the surrounding nature, discovered the healing effects of heat, cold and radiation solar and mineral waters. Instinct and observation of the world paved the way for natural but effective ways to treat pain. This literature review will be focused on the effects of peloid and balneotherapy on reducing the symptoms of arthritis and thus improving quality of life. Purpose: The purpose of this targeted systematic literature review is to examine the relationship between the treatment of peloid and balneotherapy on patients with arthritis in reducing pain, arthritic symptoms and increasing their quality of life. Methodology: A literature search was conducted using PubMed, Google Scholar, CINAHL, Science Direct databases. The search terms included balneotherapy, peloid therapy, arthritis, rheumatoid arthritis, osteoarthritis, quality of life, rehabilitation, physical activity, and pain management. Inclusion criteria: 18-65 years, published within the last 10 years, interventions related to peloid and balneotherapy, or both. An evidence level of 2b or higher was required for the inclusion criteria. Exclusion criteria includes not evaluating interventions of interest and therapeutic interventions for arthritis which are not peloid or balneotherapy related. A total of five articles (n = 5) were included in this systematic literature review. The original search criteria yielded 61 research articles related to the topic, which were then screened with the inclusion criteria with a remaining of five articles which were utilized in this review. Results: A systematic literature review of five studies was performed. Five clinical studies measured the effectiveness of balneotherapy and/or peloid therapy and there was significant difference between the groups in WOMAC pain, stiffness, and function scores and in the VAS. Discussion: This review indicates that balneotherapy and peloid therapy were effective in reducing pain, stiffness, improving function as assessed by the WOMAC and VAS scores.

Effect of Shi-Style Steaming and Bathing Decoction in Patients with Knee Osteoarthritis: Study Protocol for a Randomized Placebo-Controlled Trial.

To prove more accurately that Chinese herbal bath therapy may be a safe, effective, simple alternative treatment modality for knee OA, we designed a randomized, double-blind, placebo-controlled trial to explore the effectiveness of SSBD for the relief of pain, daily activities, and quality of life in patients with knee OA. A single-center, 52-week, randomized controlled trial of SSBD versus placebo is being performed. A total of 200 patients with symptomatic knee OA will be randomly allocated to the SSBD treatment or placebo intervention group for 4 weeks. The two groups of patients are allowed to steam and bathe their knees once every other day, using one packet of SSBD each time, for 30 minutes, 3 times a week, for a total of 4 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at 4 weeks is the primary outcome measure, and the secondary outcomes include WOMAC stiffness and function scores, the Lysholm knee scale score, quality of life, the Brief Pain Inventory score, the Patient's Global Impressions of Improvement Scale score and the Clinical Global Impressions of Severity scale score. The safety of the herbal medications will also be evaluated. We will discuss whether SSBD has greater advantages in terms of efficacy, safety, and patient overall perception than does placebo control in middle-aged and elderly patients with knee OA. The findings may provide new and valuable information about the efficacy and safety of Chinese herbal bath therapy in the treatment of knee osteoarthritis.

Association between folate intake and radiographic progression, pain function scores in subjects with radiographic knee osteoarthritis: Data from the osteoarthritis initiative.

Folate has an important role in the functioning of the musculoskeletal system, including modulation of inflammation, immunity, cartilage regeneration, prevention of osteoporosis, and maintenance of muscle strength, but evidence on the association between folate intake and knee pain, functional scores, and radiographic progression in patients with knee osteoarthritis (OA) is still limited. Our population-based cohort was extracted from the osteoarthritis initiative (OAI), focusing on individuals with prevalent radiographic knee OA (with a Kellgren-Lawrence score ≥2). Folate consumption was determined using the food frequency questionnaire. Data regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and radiographic readings were collected over 48 months. We analyzed the compiled data using generalized additive mixed models. Our cohort consisted of 1472 OA patients (626 men and 846 women, mean [SD] age 62.35 [8.92]). At the 48-month follow-up, we observed a significant correlation between higher folate intake and a slower progression of knee pain and functional scores, as evidenced by a statistically significant decrease in the WOMAC total score, WOMAC pain subscale score, and WOMAC function/disability subscale score (p < .05). The fully adjusted models estimated a reduction of -0.028 points per 50 μg/1000 kcal of daily folate intake on the WOMAC pain subscale, -0.117 points on the WOMAC function subscale, and -0.160 points on the total WOMAC scale. Furthermore, our nonparametric fit analysis suggested that a higher intake of folate might decelerate the radiographic progression of OA. Stratified analyses indicated that an increase in folate consumption might particularly benefit men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake. Higher folate intake is correlated with improved knee function and reduced pain in patients with knee OA and might deter the radiographic progression of OA. The benefits appear to be more pronounced in men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.

SURGICAL APPROACH IMPACTS PATIENT-REPORTED SYMPTOMS FOLLOWING ARTHROPLASTY FOR FEMORAL NECK FRACTURE

We aimed to examine outcomes between displaced femoral neck fracture (FNF) patients managed with total hip arthroplasty (THA) or hemi-arthroplasty (HA) via the anterolateral vs. posterior approach.We used data from the HEALTH trial (1,441 patients aged ≥50 with displaced FNFs randomized to THA vs. HA). We calculated each patient's propensity to undergo arthroplasty via the posterior approach, and matched them to 1 control (anterolateral approach) based on age (±5 years), and propensity score. We used Chi-Square/Fisher-Exact tests to compare dichotomous outcomes, and repeated measures ANOVA to examine differences in patient-reported outcomes (via the WOMAC subscores) from baseline to one-year postoperative. We used logistic regression to identify independent predictors of reoperation for instability in the posterior group.We identified 1,306 patients for this sub-analysis, 876 (67.1%) who received arthroplasty via an anterolateral approach, and 430 (32.9%) a posterior approach. The unadjusted rate of reoperation was significantly higher in the posterior group (10.7% vs. 7.1%).Following propensity score matching, we retained 790 patients (395 per group), with no between-group differences in patient, fracture, or implant characteristics. The matched cohort had a higher rate of comorbidities, and were less likely to be employed vs. the unmatched cohort. The rate of treatment for dislocation remained higher in the posterior group (6.1% vs. 2.0%) following matching.Repeated measures ANOVA revealed significantly better WOMAC pain, stiffness, function, and total scores in the posterior group. Between-group differences at 12-months were: pain - 0.59 (0.03–1.15); stiffness - 0.62 (0.35–0.87); function - 2.99 (0.12–5.86); total - 3.90 (0.24–7.56). We identified THA (vs. HA, odds ratio 2.05 [1.05–4.01]) as the only independent predictor of treatment for dislocation in the posterior group.Our analyses revealed that compromised patients with displaced FNFs who undergo arthroplasty via the posterior approach may report better symptoms at one-year vs. the anterolateral approach, despite a higher odds of reoperation for instability.

Efficacy of High-Intensity and Low-Level Laser Therapy Combined With Exercise Therapy on Pain and Function in Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.

Introduction: High-intensity laser therapy (HILT) and low-level laser therapy (LLLT) combined with exercise therapy (ET) have emerged as effective treatment options for musculoskeletal pain. However, there have remained uncertainties regarding the magnitude of their effects in reducing pain and improving function in patients with knee osteoarthritis. Hence, we performed a systematic review and network meta-analysis of available evidence in the literature to answer this query. Methods: A literature search was carried out in Embase, PubMed, and Scopus databases without any language restrictions from 1 January 1990 to 31 December 2023. We examined randomized controlled trial (RCT) studies that investigated the efficiency of HILT or LLLT plus knee osteoarthritis ET in pain and functional improvement of the knee. We performed a network meta-analysis and provided the standardized mean difference (SMD) with a 95% confidence interval (CI) by pooling the continuous data on the visual analogue scale (VAS) pain score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score using a random-effects model. Results: In total, 11 eligible RCTs were included. Our analysis revealed significant improvements in the VAS pain and WOMAC function scores on weeks 4 and 8 after interventions in groups treated with LLLT+ET and HILT+ET compared with placebo+ET. Moreover, HILT+ET showed a greater reduction in the VAS pain score (SMD=-1.41; 95% CI: -2.05 to -0.76) and improvement in the WOMAC function score (SMD=-2.20; 95% CI: -3.21 to -1.19) than LLLT+ET in week 8. Conclusion: Based on our findings, both HILT+ET and LLLT+ET treatments effectively reduced pain and improved function, but HILT+ET showed a more significant improvement in both outcomes compared to LLLT+ET.

The influence of pain catastrophizing on pain and function after knee arthroplasty in knee osteoarthritis

Pain catastrophizing is an exaggerated focus on pain sensations. It may be an independent factor influencing pain and functional outcomes of knee arthroplasty. We aimed to evaluate the association between pre-operative pain catastrophizing with pain and function outcomes up to one year after knee arthroplasty. We used data from a cohort study of patients undergoing primary knee arthroplasty (either total or unicompartmental arthroplasty) for knee osteoarthritis. Pain catastrophizing was assessed pre-operatively using the Pain Catastrophizing scale (PCS). Other baseline variables included demographics, body mass index, radiographic severity, anxiety, depression, and knee pain and function assessed using the Western Ontario and McMaster University Index (WOMAC). Patients completed the WOMAC at 6- and 12-months after arthroplasty. WOMAC pain and function scores were converted to interval scale and the association of PCS and changes of WOMAC pain and function were evaluated in generalized linear regression models with adjustment with confounding variables. Of the 1136 patients who underwent arthroplasty (70% female, 84% Chinese, 92% total knee arthroplasty), 1102 and 1089 provided data at 6- and 12-months post-operatively. Mean (± SD) age of patients was 65.9 (± 7.0) years. PCS was associated with a change in WOMAC pain at both 6-months and 12-months (β = − 0.04, 95% confidence interval: − 0.06, − 0.02; P < 0.001) post-operatively after adjustment in multivariable models; as well as change in WOMAC function at 6-months and 12-months. In this large cohort study, pre-operative pain catastrophizing was associated with lower improvements in pain and function at 6-months and 12-months after arthroplasty.

Midterm results for revision total knee arthroplasty for component malrotation

IntroductionAccurate positioning of components in total knee arthroplasty (TKA) is essential to a satisfactory outcome. Significant malrotation may lead to chronic pain, stiffness, and dysfunction. This study aims to quantify improvements in functional outcomes following revision surgery for malrotation of either one or both components in TKA versus revision for aseptic loosening. MethodsThis was a retrospective review of TKAs that matched and compared the two-year functional outcomes of the malrotation group to a functionally similar aseptic loosening group. Functional outcomes were compared between groups using Short Form (SF-12), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Knee Society Functional Score (KSFS). Student t-tests and chi-squared or Fisher’s tests were used for statistical analysis. ResultsOf the patients revised, 24 had malrotation and 57 had aseptic loosening. A total of 16 femoral and 17 tibial components were revised for malrotation. All 16 femoral components were internally malrotated (mean –4.8 ± 4.1 degrees; range, −0.5 to −16.6). Of the tibial components, 15 were internally malrotated, (mean −9.5 ± 6.6 degrees; range, −2.2 to –23.5) and 2 were externally malrotated (mean 4.6 ± 2.1 degrees; range, 3.1 to 6.0). All functional outcome measures significantly improved comparably within both groups preoperatively to 24 months postoperatively. At 24 months, functional outcome measures were comparable between the groups and WOMAC function scores were significantly higher in the malrotation group. ConclusionRevision TKA for malrotation can yield clinically and statistically significant functional improvements, similar in magnitude to those seen following revision TKA for aseptic loosening. Level of EvidenceLevel III

A phase 2b double-blind placebo-controlled randomized clinical trial of SB-061, an aggrecan mimetic, in patients with symptomatic knee osteoarthritis

ObjectivesTo evaluate the efficacy and safety of intra-articular injections of a novel aggrecan mimetic, SB-061, in subjects with knee OA. MethodsThis was a randomized, placebo-controlled, double-blind phase II study comparing intra-articular injections of SB-061 with placebo (isotonic saline) for 52 weeks, administered at baseline, Wk 16, and Wk 32. Eligible subjects had a KL grade of 2 or 3 on X-ray of the target knee and a WOMAC pain score ≥20 out of 50 at screening and baseline visits. Subjects having any other knee condition were excluded. Use of analgesics was prohibited, except for rescue medication. The primary endpoint was change from baseline (CFB) in WOMAC pain at Week 8. Secondary endpoints were CFB in WOMAC function and total, ICOAP, PGA, and 20-meter walk test. Exploratory endpoints included structural CFB in MRI entities. Results288 subjects were randomized to SB-061 (n=145) or placebo (n=143), and 252 (87.5%) completed injections. The groups were comparable at baseline. The primary endpoint was not met, as no significant difference in the CFB of the WOMAC pain score at Week 8 between groups was observed, nor at any other time point during the study. Similarly, neither of the secondary or exploratory endpoints indicated any significant difference between groups. The frequency and type of adverse events was similar between groups. SB-061 was well-tolerated. ConclusionIntra-articular injections of SB-061 administered at baseline, Wk 16, and Wk 32, over one year in subjects with knee OA was safe but did not show any statistically significant effect on knee pain nor on other symptomatic or structural entities compared to placebo. Trial registration number EudraCT No2019-004515-31

Therapeutic analysis of laser moxibustion for different KL graded knee osteoarthritis.

Our previous studies showed that laser moxibustion may be effective in alleviating the symptoms of knee osteoarthritis. However, the therapeutic effect in patients with different Kellgren-Lawrence (KL) grades is still unclear. We aimed to compare the efficacy of laser moxibustion in the treatment of knee osteoarthritis with different KL grades. A total of 392 symptomatic KOA patients with different KL grades were randomly assigned to the laser treatment or sham laser control group (1:1). The patients received laser moxibustion treatment or sham treatment 3 times a week for 4 weeks. Outcomes were measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores and Visual Analog Scale (VAS) scores, and the primary outcome measurement was the change in WOMAC pain scores from baseline to week 4. Among 392 randomized participants, 364 (92.86%) completed the trial. Participants with KL grades 2, 3, and 4 had significantly higher pain, functional, and total WOMAC scores than those with KL grade 1. Spearman correlation test results showed a positive correlation between KL grade and WOMAC pain, function, stiffness scores, and WOMAC total scores. That is, the higher the KL grade, the higher the WOMAC pain, function, stiffness, and WOMAC total scores. After 4 weeks of treatment, patients with KL grades 2 and 3 had significantly higher improvement scores in pain, function, and total scores than those with KL grade 1, whereas those with KL grade 2 had significantly higher improvement scores in stiffness than those with KL grade 1. Patients with KL grade 4 showed no significant effects after laser moxibustion treatment. Laser moxibustion is effective for pain reduction and functional improvement in the treatment of KOA with KL grades 2 and 3.

The Effect of Intra-articular Injection of Hypertonic Saline Versus Dextrose Prolotherapy for Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is the most common chronic arthritis worldwide, often causing knee stiffness, pain, and functional impairment. This study aims to compare the effects of Dextrose prolotherapy and Hypertonic saline prolotherapy on knee pain, stiffness, and function in patients with knee OA. Methods: The study was conducted as a randomized clinical trial. Patients meeting radiological and clinical criteria for knee OA were sequentially contacted and provided written informed consent. Participants were randomly assigned to receive injections of Hypertonic saline (n = 30) or dextrose prolotherapy (n = 33). The primary outcome measure was clinical manifestations assessed using the compound score of the Western Ontario and McMaster University Arthritis Index (WOMAC). Results: Within-group analysis revealed significant differences in outcome scores for both treatments after 6 months. Both Hypertonic saline and dextrose prolotherapy showed significant improvements in the Visual Analog Scale (VAS), WOMAC composite score, pain, stiffness, and function. In the first month, VAS scores were higher with hypertonic saline compared to dextrose. Additionally, stiffness decreased more with dextrose than with hypertonic saline. After 6 months of treatment, although not statistically significant, hypertonic saline showed better outcomes in the mean WOMAC composite score and pain sub-score compared to dextrose. Conclusions: Among patients with knee OA, Hypertonic saline prolotherapy administered by a trained specialist yields safe and significant improvements in knee pain, stiffness, and function. Our results suggest no significant difference in VAS and WOMAC scores between hypertonic saline and dextrose prolotherapy.

Comparison of the Efficacy of Different Combined Therapies Based on Modified Core Decompression for the Treatment of Early-stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Clinical Study.

Osteonecrosis of the femoral head (ONFH) is a severe orthopedic disease, which may cause severe hip dysfunction in later stage. Therefore, it is necessary to treat nontraumatic ONFH during the early stages. The aim of this study was to evaluate the clinical efficacy and survival rates of different combined therapies based on modified core decompression (CD) for early-stage nontraumatic ONFH. This retrospective cohort study assessed 397 hips with ONFH who underwent different combined therapies based on modified CD in our institution between January 2010 and December 2017. Patients were classified into six groups based on treatment modalities, and were followed up at 1 year and 5 years postoperatively. Clinical outcomes, including Harris hip score (HHS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC), were compared to evaluate the hip function and quick rehabilitation effect. Radiographic progression of ONFH and the incidence of total hip arthroplasty were analyzed to evaluate the survival rate of ONFH postoperatively. Statistical analyses were mainly performed with Kruskal-Wallis test, chi-square test and Kaplan-Meier method. HHS increased significantly in all groups but showed no significant differences among the six groups in the first years. The nonvascularized allogeneic fibula with bone grafting (NVAF + BG) and percutaneous femoral neck-head fenestration with bone grafting via the direct anterior approach (DAA + BG) groups had significantly higher HHS (p = 0.010; p = 0.025) and WOMAC function score (p < 0.001; p = 0.012) than the CD group 5 years postoperatively. Compared with the CD group, all the other groups showed statistically significant differences in radiographic progression (p < 0.001) and a higher survival rate with no significant difference (p = 0.569). Our study demonstrates the potential use of NVAF + BG and DAA + BG, may serve as a promising combined therapy for the treatment of early-stage nontraumatic ONFH.

Correlation Between Coronal Position Sequence of Lumbar and WOMAC Score in Knee Osteoarthritis (KOA) in Standard Standing Position.

Sagittal sequences of the spine have been shown to correlate with knee osteoarthritis (KOA), but coronal sequences and KOA have never been studied before. The study required patients to use a standard standing posture and aimed to explore the relationship between coronal position of lumbar spine and WOMAC score in KOA. This is a cross-sectional observational study. Data on a total of 268 patients with KOA were collected. Patients were photographed in a standard standing position and lumbar-sacrum offset distance (L-SOD) and lumbar-knee offset distance (ΔL-KOD) were calculated. Patients were then divided into different groups according to different critical values and differences were compared. In the L-SOD of L1-3, WOMAC function (P = 0.021, P = 0.032, P = 0.001) and total score (P = 0.039, P = 0.034, P < 0.001) were different. In the L-SOD of L3-4, WOMAC pain score were different (P = 0.001, P = 0.032). At a cutoff of 13mm, ΔL-KOD of L1-2 showed significant differences in pain part (P = 0.025, P = 0.039) and total score (P = 0.036, P = 0.050). There were significant differences in pain (P = 0.023, P = 0.027, P = 0.022), function (P = 0.048, P = 0.038, P = 0.047), and total score (P = 0.030, P = 0.027, P = 0.029) of L3-5. In the 18-mm cutoff group, only L1 and L2have differences in the pain part (P = 0.050, P = 0.038). Coronal balance of the lumbar spine is associated with knee pain and function. The pelvis plays an important role in maintaining the coronal balance. Both the lumbar spine and the knee joint should be considered when developing the surgical strategy.

Tuina on knee pain and functional decline of lower limbs for patients with mild-to-moderate knee osteoarthritis in Shanghai: protocol for a multicentre, assessor-blinded, randomised controlled trial

IntroductionKnee osteoarthritis (KOA) is one of the most common osteoarthritis, imposing substantial economic and medical burdens on both individuals and society. In China, Tuina has been selected as a complementary...

Serum ARGS-aggrecan in a phase 2 clinical trial targeting osteoarthritis

OBJECTIVETo monitor serum concentrations of the aggrecan ARGS neoepitope in a clinical trial of ADAMTS-5 inhibition as disease-modifying therapy of knee osteoarthritis, and to investigate relationships between reduction in ARGS and change in cartilage thickness, knee related pain and function. DESIGNROCCELLA trial participants received once-daily oral S201086 75, 150 or 300 mg, or placebo, for 52 weeks. Serum was collected at baseline, 4, 12, 28 and 52 weeks, and 2 weeks post treatment with ARGS measured by an in-house immunoassay. Change from baseline to week 52 in central medial femorotibial compartment cartilage thickness was measured by MRI, function and pain by WOMAC subscores. Associations between cumulative change in ARGS and change in cartilage thickness or WOMAC subscores were evaluated by linear regression. RESULTSS201086 reduced serum levels of ARGS in a dose-dependent manner throughout the treatment period. Maximal reduction was at 4 weeks with a 58.5% [95% CI 60.8%, 56.2%] reduction of ARGS compared to baseline for 300 mg S201086. Two weeks post treatment, ARGS concentrations rebounded with a dose-dependent overshoot compared to baseline levels. Cumulative change of ARGS concentration from baseline to week 52 had no effect on change in cartilage thickness (slope -0.8x10-6 [-2.9x10-6, 1.3x10-6]) or change in WOMAC pain and function (slopes -30x10-6 [-64x10-6, 5.2x10-6] and -97x10-6 [-214x10-6, 20x10-6], respectively) at week 52. CONCLUSIONSystemic inhibition of ADAMTS-5 resulted in markedly reduced serum ARGS, but change in serum ARGS concentrations showed no association with the progression of cartilage thinning, or patient reported pain and function. ClinicalTrials.govNCT03595618.