WOMAC Scores Research Articles

Comparative Study to Assess the Effectiveness and Safety of Etoricoxib & Aceclofenac in Osteoarthritis Patients

Osteoarthritis (OA) is defined as a disorder that involves the movement of limbs characterized by cellular stress and a deterioration of the outer matrix that trigger malignant remodelling responses that include inflammatory mechanisms of natural immunity. Non-steroidal anti-inflammatory (NSAID) drugs are the first choice of treatment, since they reduce pain, improve functional ability. So, by comparing the effectiveness and safety of NSAID used in the treatment of OA can enhance the quality of life of patients. The goal of the study was to compare the effectiveness and safety of Aceclofenac and Etoricoxib in OA patients as well as to assess the quality of life (QOL) and medication adherence among subjects. It is an observational study conducted in the selected Orthopaedics clinics in T. Dasarahalli, Bengaluru District for a period of 6 months, based on various inclusion and exclusion criteria. Standardized questionnaire used in the study were Western Ontario and McMaster Universities Arthritis Index, Medical Outcomes Study 36-Item Short-Form Health Survey and Morisky Medication-Taking Adherence Scale. The collected data were entered in Microsoft Excel and appropriate descriptive and inferential statistical analysis was performed. On comparing Aceclofenac and Etoricoxib in terms of WOMAC score Etoricoxib (28.42) was found to be more effective than Aceclofenac (31.61) while comparing Etoricoxib 60 mg and 90mg, 90 mg (26.22) was found to be more effective. Regarding the safety of these drugs, Etoricoxib was found to be safer than Aceclofenac in terms of side effects. On associating the QOL scores in both the groups, it was found that the subjects belonging to the Aceclofenac group had the highest overall mean score 57.68. Investigation of medication adherence in the study population revealed that out of 68 subject’s majority of them had shown low adherence (n=38). Because of its enhanced safety profile, Etoricoxib is a better option than Aceclofenac for treating .....

Dietary inflammatory index related to knee osteoarthritis symptomatology

Proinflammatory diet contributes to greater symptomatology in patients with knee osteoarthritis (KOA); however, in Mexico there seems to be no evidence of the dietary inflammatory role, being a country with high prevalence of overweight and obesity with an inclination towards a Western diet. To analyze the relationship between dietary inflammatory index (DII) and KOA symptomatology in Mexican patients. Analytical cross-sectional study in 100 patients aged 40 to 70 years. Pain, stiffness, and functionality were evaluated with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the DII was calculated from the semi-quantitative food consumption frequency questionnaire (QFCFQ). For its analysis, linear regression was calculated. DII was significantly associated with pain (p = 0.001, R² = 0.118), functionality (p = 0.003, R² = 0.087) and WOMAC score (p = 0.001, R² = 0.099). In the second linear regression model with the dependent variable functionality, waist circumference (WC) was adjusted obtaining an R² = 0.144 and higher significance p = 0.001. Proinflammatory DII was related to greater pain, lower functionality and a high WOMAC score, which is why the anti-inflammatory diet could be considered as a support for the treatment of the patient with KOA.

Association between niacin intake and knee osteoarthritis pain and function: a longitudinal cohort study.

This research investigates the relationship between niacin intake and knee osteoarthritis (OA) severity, focusing on pain and functional ability due to niacin's role as a NAD(P)+ precursor, promoting cellular energy, and offering anti-inflammatory, analgesic, and antioxidant effects. The population-based Osteoarthritis Initiative (OAI) cohort with radiographically confirmed knee OA was analyzed through a Food Frequency Questionnaire determining niacin intake and scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), using generalized additive mixed models. A significant correlation was pinpointed in 2375 OA patients (1001 men and 1374 women; 55.96% aged between 45 and 65 and 44.04% aged ≥65) between niacin intake and reduced knee pain and functional degrees after a 48-month follow-up, evident in improved KOOS and WOMAC scores (P < 0.05). The fully adjusted models estimated a decrease of 0.26 points for every additional 1 unit of Ln-niacin intake of daily niacin intake on the WOMAC pain subscale, 0.83 points on the WOMAC function subscale, and an increase of 1.71 and 1.58 on the KOOS pain and quality of life score. Strikingly, subgroups including middle-aged individuals, women, white race, obese individuals, and those with specific dietary habits showed a more substantial improvement with increased niacin. The association between increased niacin intake and reduced pain and function scores, as well improved quality of life in knee OA patients, is significant. Certain cohorts, according to a stratified analysis, could see more considerable benefits with increased niacin consumption. • Increased niacin intake is linked to reduced knee pain and better function in OA patients. • Specific subgroups, such as middle-aged individuals, women, and those with certain dietary habits, benefit more from increased niacin consumption. • Niacin shows promise for enhancing the quality of life in knee OA patients by reducing pain and improving function.

Long term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: A retrospective analysis of patients optimally managed in dedicated centers

IntroductionPRP is gaining increasing interest for pain relief and improvement of joint function in patients with knee osteoarthritis (KOA) but practices and results remain heterogeneous limiting its adoption as standard of care. Current international recommendations are to collect real-life evidence of efficacy with a systematic monitoring of PRP quality and patients' outcomes. We aimed to analyze the response of patients presenting KOA and treated with standardized PRP injection in routine care. We also investigated the potential contributing factors including patient's phenotype and PRP characteristics. MethodsPatients with symptomatic KOA and that failed first-line therapy received a single injection of a qualified PRP prepared using medical devices allowing to recover a high/very high volume of very pure PRP. Visual analogue scale (VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded at baseline and during 18 months follow-up. Results431 patients had available follow-up data at 3 months, 291 at 6 months, 137 at 12 months and 44 at 18 months. PRP induced a significant decrease of WOMAC score at all follow up endpoints (29.2 ± 19.2 at 3 months, p < 0.001 and 25.9 ± 19.7 at 12 months, p < 0.01, compared to 39.7 ± 18.9 at baseline). Similar results were observed for pain VAS (38.9 ± 23.3 at 3 months, p < 0.001 and 35.3 ± 24.1 at 12 months, p < 0.05, compared to 56.0 ± 20.7 at baseline). Changes at 12 months were correlated to baseline scores and to the level of improvement at 3 months. The proportion of OMERACT OARSI responders reached 56.2 % for the total cohort and 60.4 % for severe patients at 6 months. Treatment failure occurred for 8.4 % of patients. Age, BMI or Kellgren–Lawrence grade did not impact on efficacy. ConclusionThis real-life study evidences the clinical benefit of a standardized high or very high-volume injection of very pure PRP in patients with KOA, including those with a severe grade. It opens perspectives in the positioning of such strategy to delay arthroplasty and provide insights on factors able to anticipate long term efficacy.

A PRECISION HEALTH APPROACH FOR OSTEOARTHRITIS: PREDICTION OF RAPID KNEE OSTEOARTHRITIS PROGRESSION USING AUTOMATED MACHINE LEARNING

Precision health aims to develop personalised and proactive strategies for predicting, preventing, and treating complex diseases such as osteoarthritis (OA). Due to OA heterogeneity, which makes developing effective treatments challenging, identifying patients at risk for accelerated disease progression is essential for efficient clinical trial design and new treatment target discovery and development.To create a reliable and interpretable precision health tool that predicts rapid knee OA progression over a 2-year period from baseline patient characteristics using an advanced automated machine learning (autoML) framework, “Autoprognosis 2.0”.All available 2-year follow-up periods of 600 patients from the FNIH OA Biomarker Consortium were analysed using “Autoprognosis 2.0” in two separate approaches, with distinct definitions of clinical outcomes: multi-class predictions (categorising disease progression into pain and/or radiographic progression) and binary predictions. Models were developed using a training set of 1352 instances and all available variables (including clinical, X-ray, MRI, and biochemical features), and validated through both stratified 10-fold cross-validation and hold-out validation on a testing set of 339 instances. Model performance was assessed using multiple evaluation metrics. Interpretability analyses were carried out to identify important predictors of progression.Our final models yielded higher accuracy scores for multi-class predictions (AUC-ROC: 0.858, 95% CI: 0.856-0.860) compared to binary predictions (AUC-ROC: 0.717, 95% CI: 0.712-0.722). Important predictors of rapid disease progression included WOMAC scores and MRI features. Additionally, accurate ML models were developed for predicting OA progression in a subgroup of patients aged 65 or younger.This study presents a reliable and interpretable precision health tool for predicting rapid knee OA progression. Our models provide accurate predictions and, importantly, allow specific predictors of rapid disease progression to be identified. Furthermore, the transparency and explainability of our methods may facilitate their acceptance by clinicians and patients, enabling effective translation to clinical practice.

Effectiveness of tele-rehabilitation in patients with knee osteoarthritis: A randomized controlled trial

Objective The primary objective of this randomized controlled trial was to evaluate the effectiveness of tele-rehabilitation (TR) compared to conventional rehabilitation (CT) in reducing pain (as measured by the Numeric Pain Rating Scale [NPRS]) in patients with knee osteoarthritis (OA). Secondary objectives included assessing changes in physical function and quality of life, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-36 (SF-36) health survey, respectively. Methods Fifty-five patients diagnosed with knee OA were randomly allocated to either the TR group ( n = 29), receiving remote physiotherapy sessions three times a week for four weeks, or the CT group ( n = 26), undergoing traditional outpatient rehabilitation with the same exercise regimen. Outcomes were measured at baseline and after a three-month follow-up period. Results At baseline, there were no significant differences between groups in terms of NPRS and WOMAC scores. After three months, both the CT and the TR groups showed significant improvements in pain reduction (NPRS, p &lt; 0.001), WOMAC score ( p &lt; 0.001), and in some subscales of the SF-36 (i.e., physical functioning, role limitation attributable to physical problems, energy, and pain). Conclusion Tele-rehabilitation is an effective alternative to CT for reducing pain and improving quality of life in patients with knee OA. These findings suggest that TR can be incorporated alongside conventional approaches to provide a comprehensive treatment strategy for managing knee OA, enhancing patient outcomes in various dimensions of well-being. Trial registration NCT05719350; Telerehabilitation in Patients With Osteoarthritis (TABLET).

Increased symptoms of stiffness after opening-wedge high tibial osteotomy are associated with worse postoperative knee function outcomes and lower patient satisfaction rate.

Symptoms of knee stiffness after open wedge high tibial osteotomy (OW-HTO) can significantly affect surgical effectiveness, but no studies have reported risk factors for knee stiffness after OW-HTO. Patients treated with OW-HTO for the first time between 2018 and 2021 were included. Data were collected on patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF) 12 scores, hip-knee-ankle angle (HKA) and patient satisfaction before and after surgery. Patients with worse WOMAC stiffness scores at 1 year were defined as the 'increased stiffness' group and the other cohort as the 'non-stiffness' group. The primary outcome of the study was to compare postoperative knee function scores (WOMAC and SF-12), HKA and patient satisfaction rate between the two groups. The secondary outcome was the use of logistic regression to analyze independent predictors of increased postoperative stiffness symptoms. At 1 year postoperatively, 95 (11.3%) patients had a significant increase in stiffness. Patients had significantly (p < .001) less improvement in pain, function, and total WOMAC scores, and SF-12 score than those in the non-stiffness group (n = 745). However, the differences in WOMAC and SF-12 scores in increased stiffness group at 1year post-operatively were statistically significant (p < .001) compared to the non-stiffness group. There was no statistically significant difference in HKA in the increased stiffness group (172.9° ± 2.3°) compared to non-stiffness group (173.4° ± 2.6°) at 1year postoperatively (p = .068). Patient satisfaction was significantly lower in the increased stiffness group (p < .001). Logistic regression analysis showed that diabetes (odds ratio (OR) 1.809, p = .034) and preoperative WOMAC stiffness score of 44 or less (OR 4.255 p < .001) were predictors of increased stiffness. Patients with increased stiffness after OW-HTO had worse functional outcomes and lower patient satisfaction rates and patients at risk of being in this group should be informed pre-operatively.

Effects of Isometric Quadriceps Muscle Exercise with Visual and Auditory Feedback at 1 Year after Total Knee Arthroplasty.

To examine the effect of isometric quadriceps exercises with visual and auditory feedback after total knee arthroplasty (TKA). The sample included 41 patients from our previous study who could be followed up for 1 year after TKA. Patients in the intervention group performed isometric quadriceps exercises with visual and auditory feedback using the quadriceps training machine from the 2nd to the 14th day after TKA, whereas those in the control group underwent standard postoperative rehabilitation (without visual or auditory feedback during isometric quadriceps exercises) in the hospital. Patients were evaluated for pain intensity, timed up and go test (TUG) score, 10-m gait speed, 6-minute walking distance (6MWD), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score 1 year after TKA. Additionally, exercise habits and responses to the International Physical Activity Questionnaire (IPAQ) were investigated. Pain intensity was significantly lower in the intervention group than in the control group. Greater improvements in the TUG test scores, 10-m gait speed, 6MWD, and WOMAC scores were observed in the intervention group. Walking activity, as recorded by the IPAQ, and the proportion of patients with exercise habits were significantly higher in the intervention group than in the control group. These results suggest that performing isometric quadriceps exercise with visual and auditory feedback using the quadriceps training machine has good effects, such as pain reduction, physical function improvement, exercise tolerance, and increased physical activity at 1 year after TKA.

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications.

There is controversy about the management of unicompartmental knee osteoarthritis (OA) in young, active patients with anterior cruciate ligament (ACL) insufficiency. This study compares the subjective, radiological, and functional results of total knee replacement (TKR) vs. combined medial unicompartmental knee replacement (UKR) with ACL reconstruction. Twelve patients suffering from medial OA and ACL deficiency with varus knee deformity and/or tibial slope<10° and absence of patellofemoral-related problems were eligible for combined UKR and ACL reconstruction (Group A). Twenty-six patients matched for age, male/female ratio and body mass index who received TKR in the same time frame were included as a control group (Group B). Oxford Knee Score (OKS), WOMAC index of osteoarthritis, Knee Osteoarthritis Outcome Score (KOOS), and routine X-rays were used for assessment. Ten years after surgery, the mean overall KOOS score, OKS, WOMAC index increased from preoperatively, showing a statistically significant difference (p<0.001). In terms of KOOS, OKS, or WOMAC scores at the most recent follow-up, there was no discernible difference between the groups (p=n.s.). Three years following surgery, one female patient in group A received revision TKR due to the lateral compartment's osteoarthritis developing and the patient's pain persisting. Concerning radiographic assessment, at the most recent follow-up (average 7.9years in group A and 8.8years in group B), there were no radiographic indications of implant loosening or proof of pathologic radiolucent lines. UKR combined with ACL restoration offers clinical and radiographic outcomes comparable to TKR 10years following surgery with no elevated risk of complications.

Is radiofrequency ablation effective in treating patients with chronic knee osteoarthritis? A meta-analysis of randomized controlled trials.

This meta-analysis aimed to evaluate the short-term and long-term efficacy of radiofrequency ablation (RFA) and explore the role of diagnostic genicular nerve blocks in predicting treatment outcomes. A comprehensive literature search was conducted, and nine randomized controlled trials involving 714 participants were included in the analysis. Data extraction, risk of bias assessment, and subgroup analyses were performed. The primary outcome measures were pain scores at 6 and 12 months, assessed using visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The meta-analysis revealed that RFA demonstrated a significant short-term efficacy in reducing pain compared to the control group at 6 months, as indicated by the pain scores [weighted mean difference (WMD): -2.69, 95% CI: -3.99, -1.40]. Similarly, WOMAC scores at 6 months favored the RFA group (WMD: -4.40, 95% CI: -7.12, -1.68). However, the long-term efficacy of RFA at 12 months remained uncertain for both pain scores (WMD: -0.88, 95% CI: -2.36, 0.61) and WOMAC (WMD: 0.03, 95% CI: -0.25, 0.32). Subgroup analysis suggested that a positive result from the diagnostic genicular nerve blocks test was associated with a more favourable short-term outcome. This meta-analysis provides moderate-quality evidence supporting the short-term efficacy of RFA in reducing pain in patients with knee osteoarthritis. The inclusion of a diagnostic genicular nerve blocks test prior to RFA may help identify patients likely to benefit from the procedure. But it still needs more large sample studies to verify the results. However, further research is needed to determine the long-term efficacy of RFA in managing knee osteoarthritis pain.

Percutaneous pulsed radiofrequency ablation of articular nerves of the hip joint in patients with chronic hip pain refractory to conventional analgesics.

Total Hip Arthroplasty (THA) may be a risky proposition in patients with comorbidities, and they may require systemic analgesics for chronic hip pain (CHP). Since traditional pain medications may not provide complete pain relief or carry prohibitive adverse effects, pulsed radiofrequency (PRF) treatment of the hip articular nerves (HAN) has been proposed for effective clinical outcomes. We determined the efficacy of PRF-HAN in improvement in CHP compared to baseline pain on conventional systemic analgesics. Between August 2015 and December 2021, 31 adult patients with severe comorbid conditions and excruciating chronic hip pain were subjected to a PRF-HAN procedure following a diagnostic block. All 31 patients received PRF of the articular branches of the femoral and obturator nerves. Demographic parameters, numerical rating scale (NRS), Harris Hip Score (HHS), WOMAC scores, the change of these scores from baseline, and any adverse effects were recorded before treatment and on day 1, 1st week, 6 weeks, and 6 months after treatment. All the patients who underwent the PRF-HAN reported a significant improvement in NRS, HHS, and WOMAC scores compared to the baseline values on day 1, at the end of the 1st week, and the 6th week (p<0.001). No adverse events were documented in the study post-procedure until the end of 6 months. PRF-HAN is a strong alternative for chronic pain management and augments physical functioning and a return to daily activity in patients who would be deprived of arthroplasty considering associated comorbid conditions.

Clinical efficacy of Osteoking in knee osteoarthritis therapy: a prospective, multicenter, non-randomized controlled study in China.

Osteoking has been extensively used for the treatment of knee osteoarthritis (KOA). However, it is lack of high-quality evidence on the clinical efficacy of Osteoking against KOA and the comparison with that of nonsteroidal anti-inflammatory drugs (NSAIDs). To evaluate the efficacy and safety of Osteoking in treating KOA. In the current study, a total of 501 subjects were recruited from 20 medical centers, and were divided into the Osteoking treatment group (n = 428) and the NSAIDs treatment group (n = 73). The Propensity Score Matching method was used to balance baseline data of different groups. Then, the therapeutic effects of Osteoking and NSAIDs against KOA were evaluated using VAS score, WOMAC score, EQ-5D-3L and EQ-VAS, while the safety of the two treatment were both assessed based on dry mouth, dizziness, diarrhea, etc. After 8weeks of treatment, the Osteoking group was compared with the NSAIDs group, the VAS score [2.00 (1.00, 3.00) vs. 3.00 (2.00, 4.00)], WOMAC pain score [10.00 (8.00, 13.00) vs. 11.00 (8.00, 16.00) ], WOMAC physical function score [32.00 (23.00, 39.00) vs. 39.07 ± 16.45], WOMAC total score [44.00 (31.00, 55.00) vs. 53.31 ± 22.47) ], EQ-5D-3L score [0.91 (0.73, 0.91) vs. 0.73 (0.63, 0.83) ] and EQ-VAS score [80.00 (79.00, 90.00) vs. 80.00 (70.00, 84.00) ] were improved by the treatment of Osteoking for 8weeks more effectively than that by the treatment of NSAIDs. After 8weeks of treatment with Osteoking, the VAS scores of KOA patients with the treatment of Osteoking for 8weeks were reduced from 6.00 (5.00, 7.00) to 2.00 (1.00, 3.00) (p < 0.05), which was better than those with the treatment of NSAIDs starting from 2weeks during this clinical observation. Importantly, further subgroup analysis revealed that the treatment of Osteoking was more suitable for alleviating various clinical symptoms of KOA patients over 65years old, with female, KL II-III grade and VAS 4-7 scores, while the clinical efficacy of NSAIDs was better in KOA patients under 65years old and with VAS 8-10 scores. Of note, there were no differences in adverse events and adverse reactions between the treatment groups of the two drugs. Osteoking may exert a satisfying efficacy in relieving joint pain and improving life quality of KOA patients without any adverse reactions, especially for patients with KL II-III grades and VAS 4-7 scores. https://www.chictr.org.cn/showproj.html?proj=55387, Identifier ChiCTR2000034475.

“Shatapaki Balashwagandhadi Taila” – A 4-Week Open Single Arm Clinical Study In Janu Sandhigata Vata (Knee osteoarthritis).

Background: Ayurveda is known for its management of chronic diseases like Rheumatoid arthritis, osteoarthritis, psoriasis, etc. Osteoarthritis is one such disease that gradually develops over the years and lately affects the daily activity of humans. It is a degenerative disease that mainly affects weight-bearing joints like hip joints, knee joints, etc. It mostly affects the 40s, but now we can see it in early ages. Changing lifestyle, and improper food habits are the major reasons behind this. Osteoarthritis can be correlated with Sandhigata vata described in Ayurveda. Ayurveda proves to be very effective in managing Sandhigata vata (Osteoarthritis). According to Ayurveda Taila is the best Shamana medicine for Vata dosha. These oils when fortified 100 or 1000 times are found to be more efficient as said by Charak. Hence a study was carried out to check the effectiveness of Siddha taila in the management of Janu sandhigata vata. Objective: To study the effect of Shatpaki Balaswagandadi taila (SBAT) described by Sahastrayog in the patients of Janu Sandhigat vata. Material and Methods: This prospective open, randomized, uncontrolled clinical study was conducted at Seth R.V. Ayurvedic Hospital, Sion, Mumbai. 30 Patients having classical signs and symptoms of Janu sandhigata vata according to Ayurveda and Osteoarthritis according to modern science were selected by convenient sampling method. For the study, Gel Capsules of SBAT, 300 mg each were prepared. It was administered at the dose of 600 mg twice daily orally after meal with Anupana of Koshna jala. The duration of treatment was 30 days. Follow-up was taken on the 7th, 14th, 21st and 30th day. The study outcome included a gradation scale for classical Signs and symptoms of Sandhigata vata, VAS score, Womac score, Flexion and extension goniometric scale, and swelling. Statistical analysis was performed using appropriate statistical tests. Results: Out of 30 patients treated, 9 (30%) got excellent results, 12 (40%) got Good results, and 8 (26.67%) got Moderate results. One patient remained unimproved. There is extremely significant improvement seen in all classical symptoms of Janu sandhigat vata (p &lt; 0.0001). The VAS score, Womac, Extension goniometric scale of the right and left knee, and The flexion goniometric scale showed statistically significant changes. Conclusion: The data showed that Shatapaki Balaswagandhadi taila (SBAT) Gel capsules showed significant relief in classical signs and symptoms and modern parameters of Janu sandhigat vata.

Self-perceived Functional Disabilities due to Chronic Musculoskeletal Knee Pain among Elderly People Residing at Ahmedabad City, India: A Mixed Method Approach with a Community Perspective

Abstract Introduction: One of the disabilities perceived by elderly people which has the most profound effect on day-to-day living is knee osteoarthritis. The present study focused on elderly people with objectives of assessing the prevalence of functional disabilities due to chronic musculoskeletal knee pain with concerned determinants. Assessment of quality of life (QoL) and exploring various perceptions regarding debility were ancillary objectives. Methodology: A cross-sectional study with a mixed method approach was conducted among elderly people at urban field practice area of one of the tertiary health-care institutes of Ahmedabad city, Gujarat. The calculated sample size of 220 was collected by systematic random sampling. A pretested, validated, semistructured questionnaire including Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index with information pertaining to pain, stiffness, and functional disability was used to collect quantitative part. For qualitative assessment, in-depth interviews were taken using interview guide. Results: The prevalence of chronic knee pain was 70%, of which 63% had functional disability. Various determinants such as gender, age, socioeconomic class, occupation, and body mass index were found to have a statistically significant association with severity of knee pain/functional disability. Qualitative research revealed that majority of participants were dissatisfied with their current QoL, primarily due to dependent attitude for quotidian chores, while some of them perceived socially isolated due to compromised physical capacity. Acceptance for ailment with belief of “condition is common unpreventable fate in old-age” and surgical intervention with adverse/futile outcome in a few peer age-group cohorts enrooted attitude of not visiting any health-care facility among study participants. Conclusion: More than three-fifth of the study participants had severe/extreme WOMAC score which was most probable reason for perceived dissatisfied life quality. More than three-fifth of the study participants had severe/extreme WOMAC score representing reason for perceived dissatisfied life quality. Adopted common ethnicity of demeanor in routine chores found statistically significant association with functional disability, while certain beliefs were decisive for initiating or sustained treatment.

Assessment of Functional Outcome and Quality of Life in Patients after Total Hip Replacement in Indian Population: A Prospective Cohort Study

Introduction: Hip osteoarthritis is a major public health issue associated with a considerable loss of Health-related Quality of Life (HR-QoL). However, not all patients achieve the same level of functional improvement after Total Hip Arthroplasty (THA) and it is unclear which factors are associated with it. Aim: To determine the functional outcome and QoL in patients who underwent Total Hip Replacement (THR) in an Indian set-up. Materials and Methods: The present prospective cohort study was conducted in the Department of Orthopaedics, Eras Lucknow Medical College and Hospital, Uttar Pradesh, India, from March 2020 to September 2021. A total of 100 patients who underwent THA were included through convenience sampling. Demographic and clinical information, like name, age, gender, Body Mass Index (BMI), duration of symptoms, co-morbidity, Visual Analogue Scale (VAS) score and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, were noted from the medical records. A single follow-up of all the patients who underwent THA was conducted to assess the complications, functional outcomes and QoL using VAS score (preoperative and postoperative), WOMAC score (preoperative and postoperative), Harris Hip Score (HHS) (postoperative), Short Form-36 (SF-36) health survey (postoperative) questionnaire. The data was analysed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Continuous variables were analysed using the Wilcoxon signed-rank test for paired data. Correlation assessment was done using Pearson’s correlation coefficient for continuous factors and Spearman’s correlation coefficient for categorical factors. Results: The average age of the patients who underwent THR was 58.90±15.93 years, with a range of 17-95 years. There were 72 males and 28 females. The mean VAS score preoperatively was 7.41±1.20, which decreased significantly to 2.93±0.81 in the postoperative follow-up (p-value&lt;0.001). The mean total WOMAC score improvement was 38.51±10.26 (p-value&lt;0.001). The average postoperative HHS was 73.53±16.16, suggesting a good outcome. The average postoperative SF-36 score was 68.89±12.88. A correlation coefficient of 0.21 (p-value=0.033) suggested that the WOMAC score improvement became higher with an increase in follow-up duration. Patients with postoperative complications had a significantly lower WOMAC improvement (r-value=-0.26, p-value=0.0084). It was observed that the follow-up duration (p-value=0.047) and postoperative complications (p-value=0.016) were significant factors of WOMAC score improvement. Conclusion: Follow-up duration and the presence of postoperative complications were important factors in the functional outcome of patients who underwent THA. Knowledge of these factors can help the clinician to plan the management accordingly while counseling the patients and their relatives regarding any possible adverse outcomes.

Effect of Isometric and Dynamic Resistance Exercises on Functional Performance and Glycoprotein-bound Haemoglobin of Type 2 Diabetes Mellitus Patients with Knee Osteoarthritis: An Interventional Study

Introduction: Osteoarthritis (OA) is the most prevalent articular and rheumatologic condition, impacting over 80% of individuals aged 55 and above. There exists a significant correlation between Type 2 Diabetes Mellitus (T2DM) and OA. Both Diabetes Mellitus (DM) and OA are common afflictions. Physiotherapy plays a crucial role in alleviating pain and mitigating issues linked to the early stages of knee OA and DM. The rationale of this study is to determine whether isometric resistance exercise can achieve comparable or superior outcomes to dynamic resistance exercise in terms of long-term glycaemic control and physical function, while also being more tolerable for individuals with knee OA. Aim: To compare the efficacy of resistance exercises in diabetic patients with knee OA and specifically to examine how two resistance exercise protocols influence glycated haemoglobin (HbA1c) levels and functional performance. Materials and Methods: An interventional study was conducted using a convenience sampling technique. Approximately, 30 subjects were selected from the primary physiotherapy outpatient department in Chennai, Tamil Nadu, India. The study lasted for 12 weeks, from July 2022 to September 2022. The total population was split into two groups: Group-A received dynamic resistance exercises, whereas Group-B underwent isometric resistance exercises. Both pre- and post-treatment evaluations were performed using the Western Ontario and McMaster Universities OA Index questionnaire (WOMAC), alongside measuring HbA1c levels in all participants. Care instructions emphasised weight reduction, maintaining a balanced diet, and avoiding prolonged periods of standing. Paired t test was used to compare the pre and post test WOMAC scores and p&lt;0.05 was considered statistically significant. Results: Significant changes were observed in WOMAC scores and HbA1c pre-post comparison. The study revealed a statistically significant difference in reducing pain, enhancing functional performance, and lowering HbA1c levels among both groups (p≤0.001). Conclusion: The results indicate that both groups experienced effective pain relief and reduced HbA1c levels after the treatment period. However, subjects treated with dynamic resistance exercises demonstrated greater enhancements in functional performance and reductions in HbA1c levels compared to the isometric resistance exercises.

Functional Outcome of Subvastus versus Medial Parapatellar Approaches for Total Knee Replacement in Patients with Knee Osteoarthritis: A Prospective Cohort Study.

Subvastus approach and medial parapatellar approach are two major approaches for total knee replacement (TKR). There is no global consensus on the superiority of either approach in terms of functional outcomes. The present study aimed to evaluate the functional outcome of TKR through subvastus approach and medial parapatellar approach by using patient-reported scores at 3-, 6-, and 12-month post-operative follow-ups. This prospective cohort follow-up study included patients with knee osteoarthritis who underwent elective primary TKR either through the subvastus or medial parapatellar approaches at King Abdullah Medical City, Makkah city, Kingdom of Saudi Arabia, from January 2019 to December 2022. Scores from the self-reported Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared in the two groups of patients at 3-, 6-, and 12-month post-operative follow-ups. A total of 98 patients were included, of which 37 underwent TKR through the subvastus approach and 61 through the medial parapatellar approach. There was an overall significant change over time in both WOMAC and OKS scores (P < 0.001). Patients who underwent the subvastus approach had significantly higher mean of WOMAC and OKS than patients with the medial parapatellar approach at the 3- and 6-month follow-ups (P < 0.05), but not at the 12-month follow-up. For TKR, the medial parapatellar approach results in better functional outcomes at the 3- and 6- month follow-up periods compared with the subvastus approach.

Ayurvedic management of acute calcaneal spur with Viddhakarma and Siravedha: A case report

The feet are a highly dependent yet most neglected part of the body. The negligence may result in various levels of discomforts and associated heel pain. Abnormal pressure over foot muscles and ligaments may lead to chronic plantar heel pain and further development of calcaneal spur, which are the most encountered orthopedic problems. Various modern treatment options are available for the management of calcaneal spur, but either they involve longer duration or are expensive. Hence, there is a need to opt treatment approaches that may provide satisfactory results with minimum adversities. Viddhakarma (~therapeutic needle-piercing) and Siravedha (~therapeutic bloodletting) are the therapies of Ayurveda origin, with proven efficacy in pain management and can be used in conditions such as calcaneal spur. A 42-year-old female patient presented to the outdoor patient department in the hospital on August 17, 2022, complaining of sharp pricking pain with heat sensation in the right heel, morning stiffness in bilateral heels, and difficulty in walking for four days. On assessment, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and Foot Function Index Scale for the right foot of the patient were scored 47, 9 and 127, respectively. The X-ray of the bilateral foot (anterio-posterior and lateral view) showed an inferior bony spur projecting forward from calcaneal tuberosity more on the right side than on the left. The patient was treated with Viddhakarma, Siravedha of the right foot, along with oral Ayurvedic medicines. On completion of the treatment, the WOMAC and VAS scores were reduced significantly to 37 and 6, respectively. Further, there was a significant reduction in the Foot Function Index scale score to 96 within ten days of the treatment. Based on the clinical observations, it may be inferred that a combination of Viddhakarma, Siravedha, and oral Ayurvedic medicines can be safe, convenient, and effective in managing patients suffering from calcaneal spur. Both of these procedures can be performed by trained health-care professionals on an outpatient basis, thus convenient to the sufferers too.

Comparative Study of Inferior Pole of Patella Fracture Treated with Transosseous Technique using Modified Krackow's Technique Versus Traditional Anterior Tension Band Wiring.

The inferior pole of patella constitutes around 9.3-22% of all the patella fractures presenting to the hospital. The management of inferior pole fractures has been debated since a long from early day of partial or full patellectomy to the current dictum of open reduction and fixation because of the importance of extensor mechanism of the knee. There are various modalities of management of the inferior pole of patella fracture. The use of braided polyester wire has shown to have a higher load to failure and less implant fatigue, leading to the use of trams osseous repair technique with fiber wire as an alternative to tension ban wiring. Twenty patients were divided into two groups of 10 each: Group A comprised of patients operated with tension band wiring (TBW) and Group B with patient operated with transosseous repair. Both groups underwent the same physiotherapy postoperatively and the results were compared. Radiological outcomes and the WOMAC score of the patients are comparable in both groups. The return to full range of motion is also similar in both groups with similar physiotherapy given in both groups. This shows that with careful patient selection transosseous repair can be used as an alternative to TBW.

Long-Term Outcomes of High-Flexion Design Total Knee Arthroplasty with a Short Posterior Flange.

The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%-98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%-98.8%). The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.