WOMAC Scores Research Articles

Assessment of factors affecting quality of life in patients with chronic pain due to knee osteoarthritis and spondylosis: spine versus knee?

There is no study comparing knee and spine osteoarthritis. The purpose of the study is to examine the effects of pain and disability on quality of life (QoL) and the factors affecting QoL in patients with knee osteoarthritis and spondylosis. This cross-sectional study included 114 patients with spondylosis and 126 patients with knee osteoarthritis. Demographic data were recorded. The visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Roland Morris Questionnaire (RMQ), and the Short Form Health Questionnaire (SF-36) were filled out. Statistically, patients with spondylosis and knee osteoarthritis did not differ significantly in terms of gender, age, body mass index, number of concomitant conditions, marital status, years of schooling, pain scores, or SF-36 characteristics. SF-36 physical function, vitality, and mental health assessments were lower in women than men, while VAS scores were higher. There was no correlation between marital status, educational level, and QoL subscales. WOMAC and RMQ scores were negatively correlated with the SF-36 subscales. RMS scores were not related to mental health. Spondylosis and knee osteoarthritis affect all subscales of QoL in the same way. The management of patients with spondylosis and knee osteoarthritis should focus on pain and functionality to improve QoL.

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.

Sedentary behaviour among elderly patients after total knee arthroplasty and its influencing factors

To understand the status of sedentary behaviour in elderly patients after total knee arthroplasty and analyse its influencing factors so as to provide a reference for developing targeted interventions. Conveniently selected elderly patients undergoing total knee arthroplasty (> 6 months) in a tertiary hospital in Jiangsu Province were investigated using a general information questionnaire, the Charlson Comorbidity Index, patients’ self-reported sedentary behaviour information, the WOMAC Score, The Groningen Orthopaedic Social Support Scale, and Lee’s Fatigue. The median daily sedentary time was 5.5 h (4.5 h, 6.625 h) in 166 elderly patients after total knee arthroplasty, of whom 82 (49.40%) showed sedentary behaviour (≥ 6 h per day). Logistic regression analysis showed that being retired/unemployed (OR = 8.550, 95% CI 1.732–42.207, P = 0.0084), having a CCI score ≥ 3 (OR = 9.018, 95% CI 1.288–63.119, P < 0.0001), having high WOMAC scores (OR = 1.783, 95% CI 1.419–2.238, P < 0.0001), having a high social support score (OR = 1.155, 95% CI 1.031–1.294, P = 0.0130), and having a fatigue score ≥ 5 (OR = 4.848, 95% CI 1.084–21.682, P = 0.0389) made patients more likely to be sedentary. The sedentary time of elderly patients after total knee arthroplasty is long, and sedentary behaviour is common among them. Healthcare professionals should develop targeted sedentary behaviour interventions based on the influencing factors of sedentary behaviour in order to reduce the occurrence of sedentary behaviour in elderly patients after total knee arthroplasty.

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.

Unveiling the Pathophysiology of Osteoarthritis in Joint Anatomy

Background: Osteoarthritis (OA) is a prevalent and debilitating joint disorder characterized by the degeneration of articular cartilage and underlying bone. Understanding the pathophysiology of OA is essential for developing targeted therapies and improving patient outcomes. Objective: To explore the underlying pathophysiological mechanisms of osteoarthritis within the context of joint anatomy, focusing on cartilage degradation, synovial inflammation, and subchondral bone changes. Methods: This prospective study was conducted at private hospitals in Karachi from June 2022 to December 2022. Eighty patients aged 45 to 70 years, diagnosed with OA, were included. Detailed clinical evaluations were performed, including pain assessment using the Visual Analog Scale (VAS) and functional status assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic analysis was conducted using the Kellgren-Lawrence grading scale. Biochemical analysis of serum and synovial fluid was performed to measure levels of collagen type II cleavage products (C2C), cartilage oligomeric matrix protein (COMP), and inflammatory cytokines such as interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). Synovial fluid and tissue samples were collected during arthroscopy or joint replacement surgery for molecular pathway analysis. Data were analyzed using SPSS version 25, with correlations and regression analyses performed to identify predictors of disease progression. Results: OA was associated with significant pain and functional impairment, with a mean pain score of 7.2 ± 1.3 on the VAS and WOMAC scores averaging 55 ± 10 for physical function and 30 ± 5 for stiffness. Radiographic analysis showed 25% of patients classified as grade II, 50% as grade III, and 25% as grade IV. Biochemical markers indicated elevated levels of C2C (serum: 150 ± 20 ng/mL; synovial fluid: 200 ± 25 ng/mL) and COMP (serum: 10 ± 2 µg/mL; synovial fluid: 15 ± 3 µg/mL). Inflammatory cytokines were also elevated (IL-1β: 50 ± 5 pg/mL; TNF-α: 75 ± 10 pg/mL; IL-6: 100 ± 12 pg/mL). A strong positive correlation (r = 0.85, p &lt; 0.01) was observed between VAS pain scores and synovial IL-1β levels. Conclusion: The pathophysiology of osteoarthritis involves a complex interplay of biomechanical, biochemical, and cellular factors. The findings from this study enhance the understanding of OA mechanisms and provide a foundation for developing more effective therapeutic strategies aimed at halting or reversing the progression of OA.

Comparing technical success and clinical outcomes of macrocatheter versus microcatheter in genicular artery embolization for knee osteoarthritis

PurposeThe purpose of this study was to evaluate the comparative effectiveness and safety of using macrocatheters versus microcatheters for genicular artery embolization (GAE) in the management of knee osteoarthritis (OA). The primary outcomes were technical success and adverse events during and immediately after the procedure. The secondary outcome was the clinical outcome over the follow-up period. Materials and methodsIn our retrospective analysis, we included 79 patients undergoing GAE for OA. Patients were categorized based on the catheter type used: microcatheter through macrocatheter or directly through macrocatheter. Key parameters, including technical success, adverse events, procedure duration, radiation exposure, and clinical outcomes (VAS and WOMAC scores), were assessed at 1st, 3rd, and 6th-month intervals. ResultsTechnical success stood at 100 % for the microcatheter group, with a slight reduction for the macrocatheter group at 91 % (p = 0.069). Procedure and fluoroscopy durations were significantly shorter in the macrocatheter group (p < 0.001). Additionally, the macrocatheter group demonstrated a marked reduction in radiation dose, with notably decreased air kerma values. Clinical outcomes, including VAS and WOMAC scores at the predefined intervals, revealed no significant disparities between the two cohorts. ConclusionIn GAE procedures utilizing a temporary embolic agent (imipenem/cilastatin), initiating the intervention with a macrocatheter can be deemed cost-effective, safe and advantageous for patients with less complex vascular anatomy, as it significantly reduces procedural and fluoroscopy times, thereby minimizing radiation exposure. Conversely, in patients with intricate vascular pathways, transitioning to a microcatheter enhances technical success.

Exploring the Superior Efficacy of Hyaluronic Acid and Platelet-Rich Plasma Co-Administration Over Hyaluronic Acid Alone in Pain Reduction and Functional Status Improvement of Knee Osteoarthritis Patients

Objective: This study aimed to determine whether concurrent injection of hyaluronic acid (HA) with platelet-rich plasma (PRP) would enhance therapeutic effectiveness compared to HA alone in the management of knee osteoarthritis (OA) over a 12-month follow-up. Methodology: A prospective, comparative study was conducted in department of orthopedic Nawaz Sharif Medical College / Aziz Bhatti Shahed Hospital Gujrat from Jan 2023 To Dec 2023 on 100 patients with knee OA (Kellgren-Lawrence grades I-III). The patients were divided into two groups: Group 1, consisting of 50 patients, received intra-articular HA injections, while Group 2, comprising the remaining 50 patients, received a combination of HA and PRP. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline, and at 2, 6, and 12-months post-injection. Results: Assessments at baseline, 2 months, 6 months, and 12 months post-injection revealed significant improvement in both groups compared to baseline. However, patients in Group 2 (HA+PRP) showed significantly greater improvement than those in Group 1 (HA alone), with WOMAC scores at 2-, 6-, and 12-months yielding p-values of 0.001*, 0.001*, and 0.000*, respectively. Conclusions: The study concluded that the combination of PRP and HA is more effective than HA alone in reducing pain and improving joint function in patients with knee OA. The findings suggest that PRP+HA offers superior benefits for managing knee osteoarthritis compared to HA alone.

THE TEN-YEAR PATIENT-REPORTED AND CLINICAL OUTCOMES OF A SERIES OF 156 MOBILE-BEARING TOTAL ANKLE ARTHROPLASTIES AND THE EFFECTS OF PATIENT AGE

BackgroundTotal Ankle Replacement (TAR) is an established treatment option for end-stage ankle arthritis. We analysed at minimum, 10-year patient-reported and clinical outcomes of 156 TARs from a single centre. We specifically compared outcomes between patients under 60 and over 60 at time of surgery.MethodsData was collected retrospectively from our departmental patient database. It included all patients who underwent a TAR by a single surgeon between 2006 and 2010 and patients were divided into those under 60 and those over 60 at the time of surgery. Patient reported outcomes (PROMs), including WOMAC, SF-36 and patient satisfaction scores and complications were analysed preoperatively and at one, two, five and over 10 years postoperatively.ResultsThere were 156 patients included in this analysis, 61 were under 60 (mean age 50.29) and 95 were over 60 (mean age 69.12). A total of 12 patients had revision surgery, (nine in the under 60 group) and 52 patients were deceased at the time of analysis (10 in the under 60 group). At one year the over 60 group had less pain and better functional scores (p=0.02, p=0.017). At two, five and ten years there was no statistical difference in pain and function between groups. At two years the over 60s reported less stiffness and quicker return to activities of daily living (p=0.007, p=0.001). However, at five and 10 years there was no statistical difference in any domain.ConclusionsThis study demonstrates that age does not correlate with a significant difference in pain or functional outcomes in patients who have TAR, at over 10 years follow up. The higher revision rates in the younger group may correlate with higher functional demand and lower mortality rate.

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.

Eccentric Muscle Strengthening Using Maximal Contractions Is Deleterious in Knee Osteoarthritis: A Randomized Clinical Trial.

Objectives: To show the superiority of eccentric versus concentric strengthening in terms of improving quadriceps strength in knee osteoarthritis (OA), a randomized controlled study was conducted to perform 12 sessions of either eccentric or concentric isokinetic muscle strengthening over 6 weeks. Methods: We recruited males and females, aged between 40 and 70 years, with predominantly unilateral femorotibial OA. Exclusion criteria were having a prosthesis, inflammatory arthritis or flare-up of OA, symptomatic patellofemoral OA, cardiovascular or pulmonary disease that could be a contraindication to the study treatment, and any pathology that could cause muscle weakness. The primary endpoint was the between-group difference in change in maximum concentric isokinetic knee extension peak torque (PT) at 60°/s on the OA side at 6 weeks. Secondary endpoints were between-group difference in change in concentric hamstring PT at 60°/s; eccentric quadriceps and hamstring PT at 30°/s; 10 m and 200 m walking speeds; pain and functional status (WOMAC score) at 6 weeks and 6 months. Results: The sample consisted of 11 females and 27 males, with a mean age of 57.7 ± 7.52 years and a body mass index (BMI) of 25.95 ± 3.93 kg/m2. Quadriceps strength increased more at 6 weeks in the concentric than the eccentric group with no statistical difference. There was a rate of 25% major adverse events in the eccentric group. Conclusions: Eccentric training resulted in a smaller improvement in quadriceps strength than concentric training and was associated with a high risk of muscle injury, particularly to the hamstring muscles.

Radiological and clinical femoroacetabular impingement after slipped capital femoral epiphysis treated by in situ fixation.

The treatment of slipped capital femoral epiphysis (SCFE) is always surgical. In situ fixation (ISF) is widely accepted to stop the epiphysis slipping. Femoroacetabular impingement (FAI) is recognized as a complication after ISF and is one of the major causes of early hip osteoarthritis. The aim of this study was to characterize the relation between clinical and radiological signs of FAI. A monocentric study that included all consecutive children treated for SCFE by ISF between 2006 and 2017 was performed. Clinical examination consisted in range of motion (ROM) measurement for both hips, impingements tests and functional scores (Harris Hip Score (HHS) and Womac score). Radiological analysis was based on signs of impingement (alpha angle, anterior head neck offset (OS), anterior head neck offset ratio (HNOR). 36 hips were included. At follow-up, the difference between the mean hip ROM on the SCFE side and the healthy side were statistically significant in abduction and in internal rotation. Ten (28%) hips presented at least one clinical test positive for FAI (FADDIR and/or FABER). All the patients presented a good or excellent functional score. Eight patients (22%) presented all radiological signs of impingement; among these, 3 had a clinical sign of FAI. Twenty-eight hips (78%) presented at least one radiological sign of FAI; among these, 10 had clinical signs of FAI. Despite a high rate of radiological FAI, less than one-third of patients have clinical signs of FAI after ISF for SCEFE. III: retrospective study.

The Efficacy of Intra-articular Platelet-Rich Plasma Injection Versus Corticosteroid Injection in the Treatment of Knee Osteoarthritis: A Prospective Comparative Analysis.

Background Knee osteoarthritis (KOA) is the most typical cause of knee pain and impairment worldwide. It is typified by slow and progressive degeneration of the articular cartilage of the knee joint. Although KOA is being managed with a variety of therapies, the comparison of the effectiveness of different intra-articular injections in KOA treatment in Pakistan is still not thoroughly investigated. Therefore, the purpose of this current study is to compare the efficacy of intra-articular administration of platelet-rich plasma (PRP) and corticosteroids (CSs) in the treatment of KOA. Methods This prospective comparative study was performed among one hundred patients diagnosed with KOA in Benazir Bhutto Hospital, Rawalpindi, for one year from April 2022 to March 2023. Specified inclusion and exclusion criteria were employed for patient enrollment. Patients were divided into two equal groups through simple random sampling. Group A patients received an intra-articular injection of PRP solution whereas group B patients received an intra-articular injection of CSs. Informed consent and ethical approval were also acquired prior to data collection. A self-designed proforma based on interviews was used to collect data. The data analysis in Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) was carried out via descriptive statistics and an independent t-test. Results Women (N=71, 71%) had a higher prevalence of KOA than men (N=29, 29%). The means of study variables like age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 56.10 ± 8.70 years, 8.08 ± 1.6, and 70.08 ± 8.76 respectively. The frequency of KOA on the right side was 62% (N=62) while it was 38% (N=38) on the left side. In the study population,69% (N=69) patients had grade II KOA, and 31% (N=31) patients had grade III KOA. At the first-month, second-month, and third-month follow-up visits, there were statistically significant differences in the mean scores of the WOMAC and VAS between the study groups. However, at the first-month follow-up visit, mean scores of VAS and WOMAC were lower in group B than in group A while these were lower in group A as compared to group B, at the second-month and third-month follow-up appointments. Conclusions Intra-articular infiltration of both PRP and CSs was efficacious in the treatment of KOA-related pain and functional limitations; however, overall improvement in the PRP group was higher than CSgroup.

Short-Term Outcome of Ultrasound Therapy in Sudanese Patients with Knee Osteoarthritis

Objectives: the aim of this study is to evaluate the short term effectiveness of therapeutic ultrasound therapy modalities in patient with knee OA. Methodology: This is a prospective, double blinded clinical trial, conducted among 45 participants. Participants were divided into three groups each of 15 patients. In Group A – continuous ultrasound was used, in Group B – pulsed ultrasound was used and in Group C – traditional physiotherapy without ultrasound therapy was used. Groups A and B also received traditional physiotherapy in addition to ultrasound. Visual analog scale, WOMAC questionnaire, range of motion assessment, manual muscle test, and circumference were used for evaluation before and after rehabilitation program. Data were analyzed using Statistical Package for the Social Sciences (SPSS) and multiple regression analysis of variables was done. The ethical approval was obtained from the institutional review board at Alneelain University and a verbal and written consent was obtained from the participants before the interview. Result: When comparing the three groups, we Found that no difference in WOMAC score, and there was no differences in the edema and stiffness between the three groups. The only difference was in reduced pain (VAS) in the pulsed group (P-value 0.004*), when compared to the other two groups. Conclusion: Among 45 patients in this study we found that pulsed ultrasound therapy was very effective in reduction of pain, and there was no difference in the WOMAC index score, edema between the three groups at the end of treatment. When comparing the range of motion, Group B showed the greatest improvement in the motion. The traditional physiotherapy group(c) and the two ultrasound therapy groups (A &amp; B) had the same outcomes at the end of treatment programs. Keywords: Knee osteoarthritis, Ultrasound therapy, Pulsed ultrasound, Continuous ultrasound, Traditional physiotherapy, Effect of ultrasound therapy, Outcome of ultrasound therapy.

Understanding tightened muscle in knee osteoarthritis and the impacts of Fu's subcutaneous needling: A pilot trial with shear-wave elastography and near-infrared spectroscopy.

Given the scarce reports on the interplay between Fu's subcutaneous needling (FSN), tightened muscle, and therapeutic effects, we developed a clinical research protocol to synchronously collect data on clinical efficacy and muscle characteristics in patients with knee osteoarthritis, exploring the mechanism of FSN action. The primary aim was to assess the feasibility and safety of this protocol, guiding future trials and their sample size calculations. In this prospective, single-blind, self-controlled study, 19 patients with early to mid-stage unilateral knee osteoarthritis underwent FSN therapy on both knees over 1 week (4 sessions, every other day). We measured local elastic modulus, muscle thickness, blood flow volume, and oxygen consumption rate of bilateral vastus lateralis muscles using shear-wave elastography and near-infrared spectroscopy (NIRS) before and after the first and fourth treatments. Additionally, real-time NIRS indicators (oxygenated hemoglobin [O2Hb], deoxyhemoglobin [HHb], total hemoglobin [THb], and tissue saturation index [TSI]) were recorded during these treatments. Pain intensity (visual analogue scale [VAS]), functional status (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and active range of motion were evaluated before these treatments. All 19 participants completed the trial without serious adverse events. After 3 FSN treatments, significant changes were observed in VAS and WOMAC scores (VAS: P < .001; WOMAC: P < .001), and knee flexion (P < .001) and external rotation (P = .02), except for internal rotation. No meaningful significant differences were observed in muscle characteristics at baseline or between pre- and post-treatment periods. NIRS results during treatments indicated significant increases in local O2Hb and THb post-FSN therapy (First treatment: O2Hb: P = .005; THb: P = .006. Fourth treatment: O2Hb: P = .002; THb: P = .004); however, no significant increases were observed for HHb (First treatment: P = .06; Fourth treatment: P = .28). No linear correlation was found between therapeutic effects and changes in tightened muscle indices. FSN reduces pain and improves joint function in knee osteoarthritis, while also enhancing blood flow and oxygenation in the vastus lateralis muscle of the affected side. Further revisions of this protocol are warranted based on our insights.

Effects of Platelet-Rich Plasma Combined with Physical Therapy on IL-1β, TGF-β1, and MMP-3 in Patients with Knee Osteoarthritis.

The occurrence of osteoarthritis in the knee joint is regulated by a complex network, and there is currently no specific therapeutic drug available. Functional exercises and treatments targeting inflammatory factors have shown the potential to alleviate knee osteoarthritis to some extent. Therefore, the aim of this study was to assess the intra-articular injection (IAI) of autologous platelet-rich plasma (PRP) combined with physical therapy (PT) in treating knee osteoarthritis. A total of 128 patients with knee osteoarthritis were included in the study, including 64 males and 64 females. A total of 128 patients were divided into sodium hyaluronate group (HA group), PRP group, PRP + PT group, and PT group, with 32 cases in each group. Visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Japanese Orthopaedic Association (JOA) were employed to evaluate the recovery of patients from pain and osteoarthritis. Color Doppler ultrasound imaging technology was utilized to assess joint effusion, synovial membrane thickness, and articular cartilage thickness in patients with knee osteoarthritis. Enzyme-linked immunosorbent assay (ELISA) was employed to detect the levels of interleukin-1β (IL-1β), transforming growth factor-β1 (TGF-β1), and matrix metallopeptidase 3 (MMP-3) in the synovial fluid. Compared to the HA group, the PT group, PRP group, and PRP combined with PT (PRP + PT) group all showed reduced VAS and WOMAC scores, increased JOA scores, decreased joint effusion, synovial membrane thickness, and articular cartilage thickness in the knee joint. Additionally, levels of IL-1β and MMP-3 in the synovial fluid decreased, while TGF-β1 levels increased (P < 0.05). Compared with the PT group, the VAS and WOMAC scores of the knee joint in the PRP group decreased, JOA scores increased, joint effusion, synovial thickness, and articular cartilage thickness decreased, but there was no statistically significant difference (P > 0.05), and the PRP + PT group showed decreased VAS and WOMAC scores, increased JOA scores, reduced joint effusion, synovial membrane thickness, and articular cartilage thickness in the knee joint. Moreover, levels of IL-1β and MMP-3 in the synovial fluid decreased, while TGF-β1 levels increased (P < 0.05). No severe adverse reactions were observed in any of the four groups, but the pain rate in the PRP + TP group was significantly lower than PT group, PRP group, and PRP + PT group (P < 0.05). The efficacy of intra-articular injection of PRP combined with exercise therapy in the treatment of knee osteoarthritis is superior to that of single interventions such as simple interventions of HA, PRP injection, and PT. Furthermore, intra-articular injection of PRP combined with exercise therapy demonstrates enhanced effectiveness in improving the inflammatory levels associated with knee osteoarthritis and facilitating the rehabilitation process.

Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort

BackgroundHip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort. MethodsPatients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation. ResultsThe study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure. ConclusionsThe ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.

Demographic, pain, and quality of life factors in unilateral and bilateral total knee arthroplasty

BackgroundThe Alberta Bone and Joint Health Institute (ABJHI) has a comprehensive registry capturing clinical, demographic, and patient-reported outcome measures on all knee arthroplasties performed in the province of Alberta, Canada. This large database provides an opportunity to study the outcomes of total knee arthroplasties (TKA) in patients who underwent unilateral or bilateral procedures. MethodsPain and quality of life outcomes of 29,157 TKAs performed in 23,033 patients for knee osteoarthritis performed in Alberta, Canada from January 2013 to February 2020 were examined. This study: (1) investigates whether having both knees replaced results in better pain and quality of life outcomes than replacing only one knee (using multivariate analysis of variance) and (2) identifies if pain and quality of life outcomes impact the likelihood of needing surgery in the contralateral knee after a first TKA (using univariate and multivariate Cox proportional hazards models). Patient-reported outcomes were measured using questionnaires: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to assess knee pain, and the EuroQol-5D-5L (EQ-5D) to assess quality of life. ResultsPatients who had surgery on both knees had approximately 5% better WOMAC (pain) and EQ-5D (quality of life) questionnaire scores 12 months post-surgery than those who had surgery on only one knee. Additionally, for every 1-point higher pre-operative WOMAC pain score (i.e., less pain) there was a 1% decreased likelihood of undergoing a contralateral TKA compared to a 46% decreased likelihood per 1-point improvement in quality of life. Dementia, back pain, and hospital readmission were associated with a 68%, 17%, and 44% decreased likelihood of contralateral TKA respectively. By contrast, patients with obesity were 36% more likely to undergo bilateral TKA (p &lt; 0.05). ConclusionsPreoperative knee pain and quality of life play a statistically significant role in determining which patients undergo bilateral TKA. Additionally, bilateral TKA resulted in better patient-reported outcomes compared to unilateral TKA. Though clinical significance cannot be drawn from the low response rates for the patient-reported outcomes, these findings provide a basis for future research on patient-reported outcomes within the Canadian healthcare system.

Comparative Analysis of Cemented and Cementless Straight-Stem Prostheses in Hip Replacement Surgery for Elderly Patients: A Mid-Term Follow-up Study

This retrospective cohort study assesses the effectiveness of straight-stem cementless versus cemented prostheses in hip replacement surgeries for elderly patients with femoral neck fractures. We analyzed 80 patients aged 70 and over who underwent surgery between 2018 and 2021. Clinical outcomes were evaluated using the Harris Hip Score, WOMAC Score, and Visual Analogue Scale, alongside radiological assessments through Brooker’s classification. Preoperative Dorr classification and five postoperative criteria (subsidence, cortical hypertrophy, pedestal sign, radiolucent lines, and stress shielding) were used to assess implant efficacy. The results demonstrated satisfactory mid-term outcomes for both groups, with slightly higher clinical scores observed in the cementless stem group. The Harris Hip Score (HHS) averaged 74.4 ± 6.7 in the cemented group and 79.2 ± 10.4 in the cementless group, with a statistically significant difference (p = 0.0146). The WOMAC Score showed an average of 30.1 ± 4.6 in the cemented group compared to 27.1 ± 6.9 in the cementless group, also indicating a statistically significant improvement (p = 0.0231). However, radiographic findings call for a re-evaluation of long-term stability. Our statistical analysis, which included power calculation and multivariate analysis to adjust for confounding variables, offers a comprehensive assessment of implant effectiveness. The findings contribute to the ongoing debate on the choice between cemented and cementless prostheses, indicating that both are viable options catering to different patient needs. Further research overcoming this study’s limitations is crucial for a deeper understanding of optimal treatment strategies in hip replacement surgery for the elderly.

Effect of Dynamic Balance Training on Physical Function and Proprioception in Individuals with Knee Osteoarthritis

Background: Osteoarthritis (OA) is a prevalent joint disorder affecting synovial joints, particularly the knee. It leads to degeneration of cartilage, causing pain and reduced physical function. Effective treatment strategies are essential for managing symptoms and improving quality of life. Objective: To determine the effect of dynamic balance training on physical function and proprioception in individuals with knee osteoarthritis. Methods: This quasi-experimental trial was conducted at Riphah International University Lahore, Aziz Medical Clinic, and Ali Hospital, Mughal Pura Lahore. A total of 48 patients with anterior knee pain were recruited and divided into two groups: one receiving dynamic balance training and the other receiving conventional physical therapy (control). Non-probability convenience sampling was used. Outcomes were measured using NPRS, a goniometer, the Community Balance and Mobility Scale (CB&amp;M), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Knee proprioception was assessed by joint position sense using a universal goniometer, with the average of three angles taken for the final reading. Data were analyzed using SPSS version 25. Results: Significant differences were observed in joint proprioception between weight-bearing (WB) and non-weight-bearing (NWB) procedures. The mean difference for WB was -3.07 compared to -2.18 for NWB, with a higher relative error in WB (p &lt; 0.05). Dynamic balance training resulted in greater reductions in NPRS scores and improvements in WOMAC scores compared to conventional physical therapy (p &lt; 0.05). Conclusion: Dynamic balance training was more effective than conventional physical therapy in improving physical function and proprioception in individuals with knee osteoarthritis.

Is There a Need for an Exogenous Activator Along with PRP for Early Knee Osteoarthritis? A Triple-Blinded Randomized Control Trial.

In addition to other variables associated with PRP injections for Knee Osteoarthritis (OA), some confusion exists about the role of exogenous activators. The current study looks at matched groups getting PRP injections with or without activator (Calcium gluconate) in early knee OA patients. Patients of early OA knee meeting inclusion criteria were randomly divided into 2 groups; Group A (43 patients) received 8ml PRP injection alone, and Group B (48 patients) received 8ml PRP along with 2ml Calcium gluconate as activator. The patients were evaluated at baseline, 6weeks, 3months and 6months for WOMAC Pain and Total WOMAC scores; secondary variables assessed were VAS score and patient satisfaction. The baseline characteristics of both groups were comparable. Leucocyte-depleted PRP with 5 times concentration and average absolute platelet numbers of 7.144 billion per knee was injected. Mean Pain WOMAC scores decreased in both groups from baseline (group A-8.68, group B-9.09) to final follow-up (group A-4.67, group B-5.11). Similarly, Mean Total WOMAC scores decreased from baseline (group A-37.81, group B-37.41) to (group A-21, group B-21.36) at the final follow-up in both groups. There was no significant difference between both groups, and both showed similar trends. Similar findings were noted for VAS scores. Patient satisfaction was also not different (group A, 90.69%, group B, 89.58%) at the end of 6months. Our study concluded doubtful role of adding exogenous activator to PRP preparation. The online version contains supplementary material available at 10.1007/s43465-024-01159-7.