Effects of a Hybrid Teaching Program on Lower Limb Muscle Strength, Knee Function, and Depression in Older Adults After Total Knee Replacement: A Randomized Controlled Trial.

The aim of the current study was to evaluate the effects of a nurse-led hybrid teaching program on lower limb strength, knee function, and depression in older adults after total knee replacement (TKR). This was a single-blind, randomized controlled trial. Fifty-two patients who underwent TKR were randomly assigned to either the experimental group (EG; n = 26), which received routine care plus 16 weeks of home rehabilitation through a hybrid teaching program, or the control group (CG; n = 26), which received routine care only. The intervention included pre-discharge face-to-face education, video instructions to follow at home after discharge, and four monthly telephone-based follow ups during the 16 weeks post-surgery. After the 16-week intervention, participants in the EG exhibited improved quadriceps strength, hamstring strength, and Knee Injury and Osteoarthritis Outcome Score (KOOS) compared to those in the CG. Generalized estimating equation analyses revealed a significant group-by-time interaction effect on quadriceps strength, overall KOOS score, and Geriatric Depression Scale-Short Form score. Findings suggest that a nurse-led hybrid teaching program enhances physical and psychological function after TKR when compared to routine care. This hybrid teaching program, involving exercise and postoperative education, proves to be a feasible and cost-effective intervention for improving outcomes in older adults following TKR. Health care teams should consider it as a viable home rehabilitation option for older adults who undergo TKR. [Research in Gerontological Nursing, 17(1), 31-40.].

Persistent altered knee loading in patients with meniscectomy: A systematic review and meta-analysis.

OBJECTIVES: To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy. DESIGN: Meta-Analysis. SETTING: Laboratory. PARTICIPANTS: 332 meniscectomy patients and 137 healthy controls (from 13 qualified studies) MAIN OUTCOME MEASURES: Cohen's d effect sizes (ESs) were calculated to compare KAM and KFM values of the surgical legs to the non-surgical and to healthy control legs. RESULTS: When compared to healthy controls, meniscectomy patients' surgical legs demonstrated a significantly greater KAM (ES = 0.310; P = 0.002) but no significant difference in KFM (ES = -0.182; P = 0.051). When compared to the patients' non-surgical legs, however, the surgical legs showed no difference in KAM (ES = -0.024; P = 0.716) but a significantly lower KFM (ES = -0.422; P < 0.001). High heterogeneity among study ESs was observed in patients' between-limb comparison for KAM (Q-value = 20.08, P = 0.005; I2 = 65.1%) and KFM (Q-value = 43.96, P < 0.001; I2 = 79.5%). However, no significant differences in study ESs (all P > 0.102) of KFM and KAM were identified when comparing studies with various times post-surgery, weight-bearing tasks, walking speeds, or patient demographics. CONCLUSION: Elevated KAM and reduced/asymmetrical KFM observed in meniscectomy patients may contribute to the increased risk of knee OA. Rehabilitation should focus on movement education to restore between-limb KFM symmetry and reduce KAM bilaterally post-meniscectomy.

Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: The objective of the study was to evaluate the effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis (KOA). METHODS: Five databases (PubMed, Embase, Cochrane Library, CINAHL, Web of Science Core Collection) were searched for relevant randomized controlled trials (RCTs) published from database inception to 2 August 2022. The Cochrane Collaboration's standards were followed for study selection, eligibility criteria, data extraction and statistics, using the Cochrane Collaboration Risk of Bias Tool and PEDro for quality assessment. A meta-analysis and subgroup analyses, stratified by control condition and intervention duration, were conducted using RevMan 5.4. The study was reported in compliance with the PRISMA statement. RESULTS: A total of 12 independent RCTs with 1442 participants were included. The meta-analysis showed that the home-based exercise interventions significantly reduced pain in individuals with KOA (SMD = - 0.32, 95% CI [- 0.41, - 0.22], p < .01) and improved physical function (SMD = - 0.25, 95% CI [- 0.47, - 0.02], p = .03) and quality of life (SMD = 0.63, 95% CI [0.41, 0.85], p < .001). Subgroup analysis revealed that home-based exercise interventions were superior to health education and no treatment, in terms of pain and physical function, and similar to clinic-based exercise and pharmacologic treatment. CONCLUSIONS: The effect of home-based exercise intervention is significantly better than health education and no treatment for reducing knee pain and improving physical function, and was able to achieve the effects of clinic-based exercise treatment and pharmacologic treatment. With regard to quality of life, the unsupervised home strength exercise intervention showed a significant effect compared with the health education control and combined with cognitive behavioural therapies may produce better results. Although home-based intervention provides effective treatment options for individuals with clinical treatment limitations, individual disease complications and the dosimetry of exercise need to be considered in practice. Furthermore, growing evidence supports the effectiveness of Tai Chi in the rehabilitation of KOA.

Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review With Meta-analysis.

OBJECTIVE: To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surgery. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: The authors searched the MEDLINE/PubMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science, and Scopus databases from their inception until March 2022. STUDY SELECTION CITERIA: The authors included peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation. DATA SYNTHESIS: We assessed bias using the Cochrane Risk-of-Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardized mean differences (Hedges' g) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low to very low certainty of evidence favored prehabilitation over no intervention for improving knee functioning before (g = 1.23; 95% CI: 0.49, 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month, g = 0.90; 95% CI: 0.18, 1.61; mid-term: 6 weeks to 3 months, g = 0.45; 95% CI: 0.06, 0.84). There were no significant between-group differences at long-term follow-up (6-12 months, g = 0.07; 95% CI: -0.17, 0.30). CONCLUSION: There was low to very low certainty of evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive. J Orthop Sports Phys Ther 2022;52(11):709-725 Epub: 20 September 2022. doi:10.2519/jospt.2022.11160.

Evaluation of a collaborative ambulatory orthopedic care program for patients with hip and knee osteoarthritis: a comparative observational cohort study.

BACKGROUND: In 2014, the novel orthopedic care program was established by the AOK health insurance fund in southern Germany to improve ambulatory care for patients with musculoskeletal disorders. The program offers extended consultation times, structured collaboration between general practitioners and specialists, as well as a renewed focus on guideline-recommended therapies and patient empowerment. The aim of this study was to assess the impact of the program on health service utilization in patients with hip and knee osteoarthritis (OA). METHODS: This retrospective cohort study, which is based on claims data, evaluated health service utilization in patients with hip and knee OA from 2014 to 2017. The intervention group comprised OA patients enrolled in collaborative ambulatory orthopedic care, and the control group received usual care. The outcomes were participation in exercise interventions, prescription of physical therapy, OA-related hospitalization, and endoprosthetic surgery rates. Generalized linear regression models were used to analyze the effect of the intervention. RESULTS: Claims data for 24,170 patients were analyzed. Data for the 23,042 patients in the intervention group were compared with data for the 1,128 patients in the control group. Participation in exercise interventions (Odds Ratio (OR): 1.781; 95% Confidence Interval (CI): 1.230-2.577; p = 0.0022), and overall prescriptions of physical therapy (Rate Ratio (RR): 1.126; 95% CI: 1.025-1.236; p = 0.0128) were significantly higher in the intervention group. The intervention group had a significantly lower risk of OA -related hospitalization (OR: 0.375; 95% CI: 0.290-0.485; p < 0.0001). Endoprosthetic surgery of the knee was performed in 53.8% of hospitalized patients in the intervention group vs. 57.5% in the control group; 27.7% of hospitalized patients underwent endoprosthetic surgery of the hip in the intervention group versus 37.0% in the control group. CONCLUSIONS: In patients with hip and knee OA, collaborative ambulatory orthopedic care is associated with a lower risk of OA-related hospitalization, higher participation in exercise interventions, and more frequently prescribed physical therapy.

Effect of Proprioception and Balance Training Combined with Continuous Nursing on BBS Score and HSS Score of Patients Undergoing Total Knee Arthroplasty.

Background: Total knee arthroplasty is one of the most effective methods for the treatment of end-stage knee osteoarthritis, but 10% of patients still show insufficient function, strength, and mobility. Continuous nursing service plays an important role in the rehabilitation of patients undergoing total knee arthroplasty. For discharged and convalescent patients, the traditional follow-up model cannot solve the nursing problems of discharged patients. How to meet the health needs of discharged patients under the limited nursing resources has become an existing problem. Objective: To explore the effect of proprioception and balance training combined with continuous nursing on Berg balance scale (BBS) score and Hospital for Special Surgery (HSS) score of patients undergoing total knee arthroplasty (TKA) is the objective of this study. Methods: Sixty patients undergoing TKA in our hospital from December 2019 to April 2021 were enrolled. The patients were randomly assigned into the control group and the study group. The control group received continuous nursing, and the study group received proprioception and balance training combined with continuous nursing. Results: The nursing satisfaction of the study group was higher than that of the control group (P < 0.05). The HSS scores at discharge, 1 month, 3 months, and 6 months after discharge in the study group were higher than those in the control group (P < 0.05). It was higher in the study group than in the control group at 1 month, 3 months, and 6 months after discharge (P < 0.05). The pain catastrophizing score of the study group at discharge was lower than that of the control group at 1 month, 3 months, and 6 months after discharge (P < 0.05). The BBS scores at discharge, 1 month, 3 months, and 6 months after discharge in the study group were higher than those in the control group (P < 0.05). The Lindmark balance scores at discharge, 1 month, 3 months, and 6 months after discharge in the study group were lower than those in the control group (P < 0.05). Conclusion: Proprioception and balance training combined with continuous nursing can effectively promote the recovery of knee joint function of patients after TKA, enhance patients' pain catastrophizing grade, enhance patients' quality of life, effectively promote patients' knee joint function and BBS score, and promote the improvement of disease.

Effect of Remote Control Augmented Reality Multimedia Technology for Postoperative Rehabilitation of Knee Joint Injury.

This study was aimed at exploring the application value of augmented reality (AR) in postoperative rehabilitation training for patients with knee joint injury. 40 patients who underwent knee joint injury surgery were selected as the research objects, and the patients were randomly divided into two groups: an experimental group (20 cases) and a control group (20 cases). Patients in the experimental group were treated with AR-based rehabilitation methods, while those in the control group were treated with traditional rehabilitation methods. Afterwards, the two groups of patients were compared with various indicators such as pain value, swelling, structural and functional recovery, time to complete weight bearing, time to return to work, and X-ray examination results. The main evaluation tools used were Hospital for Special Surgery (HSS) score and Visual Analogue Scale (VAS) score. The results showed that after six weeks, the HSS score of the control group was 82.88 ± 3.07, and the HSS score of the experimental group was 85.46 ± 3.21. The difference between the two groups was statistically significant (P < 0.05). After three months, the HSS score of the control group was 89.96 ± 3.76, and that of the experimental group was 93.21 ± 4.33. The difference between the two groups was statistically significant (P < 0.05). There was a significant difference in pain scores between the two groups at 7 days (3.81 ± 0.48 vs. 5.06 ± 0.66) and 14 days (2.03 ± 0.45 vs. 3.61 ± 0.63) after surgery, with statistical significances (P < 0.05). There were statistically significant differences between the two groups in terms of time to complete weight bearing (7 ± 0.87 weeks vs. 8.82 ± 0.88 weeks) and time to return to work (8.69 ± 0.94 vs. 9.93 ± 0.88 weeks) (P < 0.05). One month after surgery, the X-ray examination results of both groups showed recovery. The AR-based rehabilitation training system showed a good application effect and prospect in the postoperative structural and functional recovery of patients with knee joint injury.

Translation, cross-cultural adaptation, validation and responsiveness in the Brazilian Portuguese version of the Knee Injury and Osteoarthritis Outcome Score (KOOS-BR).

PURPOSE: To carry out the translation, cultural adaptation, and validation in the Brazilian Portuguese version of Knee Osteoarthritis Outcome Score (KOOS-BR) in individuals with knee osteoarthritis (KOA). METHODS: Patients with KOA (n = 136) answered KOOS-BR, Short-Form Health Survey (SF-36) and Numerical Pain Scale (NPS) to access construct validity. KOOS-BR was answered again with an interval of five to eight days. The following were performed: Cronbach's alpha to assess internal consistency, intraclass correction coefficient (ICC2,1) to assess reproducibility, standard error of measurement (SEM) and minimal detectable change (MDC) as error measurements. Dimensionality was tested through confirmatory factor analysis (CFA). Responsiveness was investigated by the correlation between KOOS-BR subscales with global perceived effect (GPE) before and after physical therapy treatment for 6 weeks. Floor and ceiling effects (< 15%) were also assessed. RESULTS: KOOS-BR version showed good test-retest reliability in all KOOS-BR subscales (ICC = 0.77-0.84), with proper internal consistency (α = 0.71-0.94). KOOS-BR showed a moderate direct correlation with physical health domains of SF-36 (r = 0.39-0.68; p < 0.001) and a moderate inverse correlation with pain intensity (r = - 0.51 to - 0.57; p < 0.001). KOOS-BR proved to be responsive, the correlation between the KOOS-BR subscales and GPE before and after treatment ranged from 0.42 to 0.60 (p < 0.001). There was no ceiling and floor effect. CONCLUSION: KOOS-BR is reliable, valid, and responsive in patients with KOA. LEVEL OF EVIDENCE: II.

Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial.

PURPOSE: This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT. METHODS: A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia. RESULTS: There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05). CONCLUSION: Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA. LEVEL OF EVIDENCE: II.

Efficacy and safety of a self-developed home-based enhanced knee flexion exercise program compared with standard supervised physiotherapy to improve mobility and quality of life after total knee arthroplasty: a randomized control study.

BACKGROUND: This randomized controlled study compared standard supervised physiotherapy (SPT) with a self-developed, home-based, enhanced knee flexion exercise program involving a low stool (KFEH) in patients who underwent total knee arthroplasty (TKA). METHODS: Patients were recruited from July 2014 to December 2015 and randomly assigned to one of two groups: KFEH (n = 60) and SPT (n = 59). Outcomes (joint function) were evaluated according to the Knee Society Score (KSS), visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and range of motion (ROM) assessment at selected time points (preoperatively; 1 week; 1, 3, and 6 months; and 1 year after surgery). RESULTS: Pain and functional improvement were observed in both groups. Non-inferiority of KFEH was evident 12 months postoperatively; however, patients in the KFEH group exhibited better ROM at 1 month (P < 0.01). Absolute WOMAC and KSS scores were slightly better in the KFEH group, although the difference was not statistically significant. There was no difference in VAS scores and complication rates between the two groups. Additionally, the home program would save patient time and decrease the economic burden associated with in-hospital SPT. CONCLUSION: Considering rehabilitation and economic efficiency as well as the COVID pandemic, a home-based enhanced knee flexion exercise program for TKA rehabilitation is recommended.

Posterior tibial slope is a modifiable predictor of relatively large extension gaps in total knee arthroplasty for degenerative osteoarthritis.

BACKGROUND: During total knee arthroplasty (TKA) for osteoarthritis, the sagittal gap imbalance (SGI) with a relatively large extension gap is an important surgical challenge. We determined the predictors of SGI with a relatively large extension gap and evaluated the surgical outcomes of knees with SGI. METHODS: 551 consecutive cases of primary TKA for osteoarthritis were retrospectively reviewed. The cohort was divided into two groups according to the SGI and statistically matched according to baseline characteristics via the inverse probability of treatment weighting method. Multiple linear and logistic regression analyses were performed to determine the predictors of sagittal gap difference (SGD) and SGI. Intergroup differences in clinical and radiological outcomes were analyzed. RESULTS: Of all the knees included, 8.5% (n = 45) presented with SGI with a relatively large extension gap and required femoral sagittal balancing to manage SGI. The hyperextension angle (HA), preoperative joint line convergence angle (JLCA), and the change in posterior tibial slope (PTS) significantly correlated to SGD and predicted SGI with a relatively large extension gap. SGI group showed significant changes in femoral posterior condylar offset and joint line height compared to those without SGI (1.48 vs -0.45, 1.37 vs -0.51, respectively). Postoperative ROM and knee society knee scores were lower in SGI group. CONCLUSION: Knees requiring sagittal balancing to manage SGI with a relatively large extension gap is not uncommon in TKA for osteoarthritic knees. The change in PTS is an independent and modifiable predictor of SGI.

The effectiveness of traditional Chinese medicine fumigation and washing nursing care after arthroscopic debridement of Knee Osteoarthritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of meniscus have become common methods for the treatment of KOA. However, postoperative pain, swelling and limited joint movement affect the functional recovery of knee joint and the effect of surgical treatment. Early postoperative control of pain and swelling is of great significance to improve the curative effect of arthroscopic debridement and promote the recovery of knee joint function. In recent years, many clinical studies have reported that the nursing method of fumigation and washing with Chinese medicine after arthroscopic debridement of KOA can relieve pain, promote the recovery of joint function and improve the clinical curative effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of fumigation and washing with traditional Chinese medicine after KOA arthroscopy. METHODS: Computer retrieval English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc), moreover manual retrieval academic, Google and baidu from building to since December 2020, traditional Chinese medicine fumigation applied to KOA arthroscopy postoperative nursing of randomized controlled clinical research, by two researchers independently evaluated the quality of the included study and extracted the data. Meta-analysis of the included literatures was performed using RevMan5.3 software. RESULTS: The main observation index of this study was the effective rate, and the secondary indexes included Visual Analogue Scale Score, the Western Ontario and McMaster university orthopedic index, Lysholms score and adverse reactions, so as to evaluate the efficacy and safety of traditional Chinese medicine fumigation nursing after KOA arthroscopy. CONCLUSION: This study will provide reliable evidence for the clinical application of Fumigation and washing nursing of traditional Chinese medicine after KOA arthroscopy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/THZP4.

Which is the better choice? A clinical cohort study protocol evaluating the differences between standard medial parapatellar and minimally invasive approaches in total knee replacement.

BACKGROUND: There is still a lack of consensus on the best approach for total knee replacement (TKR). We carried out this present retrospective cohort study to assess the overall safety and effectiveness of a minimally invasive approach without the use of computer navigation in comparison with conventional TKR. METHODS: A retrospective review of patients who receiving the primary TKR in the same institution from 2014 to 2016 was conducted. The inclusion criteria for the study indicated that the patient required a unilateral or bilateral TKR was between 18 and 80 years' old, provided informed consent, was followed up for at least 2 years, and was in stable health. There was no treatment for any condition or condition that might pose a risk of excessive surgery. The same TKR standard rehabilitation program was provided to all patients. Data were collected on patient demographics, anesthesia style, American Society of Anesthesiology scores, tourniquet duration, and surgical drainage loss. Our primary outcome measure was discharge time. Secondary outcomes included duration of surgery, incidence of postoperative complications, imaging location 6 weeks after surgery, Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index, and knee ROM. Complications were recorded and classified as surgical site, thromboembolic, systemic, or requiring reoperation. RESULTS: It was assumed that there is a remarkable difference in postoperative outcomes between the 2 groups. CONCLUSION: The limitations of our present research include the inherent limitations in any retrospective cohort research, including the observation bias and possibility of selection. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6349).

Associations between comorbidities and immediate and one-year outcomes following supervised exercise therapy and patient education - A cohort study of 24,513 individuals with knee or hip osteoarthritis.

OBJECTIVE: To investigate if comorbidities are associated with change in health outcomes following an 8-week exercise and education program in knee and hip osteoarthritis (OA). METHODS: We included 24,513 individuals with knee or hip OA from the Good Life with osteoArthritis in Denmark (GLA:D®). GLA:D® consists of two patient education sessions and 12 supervised exercise sessions. Before the program, individuals self-reported having one or more of 11 common comorbidities. Physical function was assessed using the 40-m Fast-Paced Walk Test (FPWT, m/sec) before and immediately after the program. Pain intensity and health-related quality of life was self-reported before, immediately after, and at 12 months post-intervention using a visual analogue scale (VAS, 0-100) and the EQ-5D-5L index (-0.624 to 1.000), respectively. Associations of comorbidity combinations with change in outcomes immediately and at 12 months was estimated using mixed linear regression. RESULTS: Individuals with OA improved on average 0.12 m/s (95%CI 0.12 to 0.13) in 40-m FPWT, -12.7 mm (95%CI -13.2 to -12.2) in VAS, and 0.039 (95%CI 0.036 to 0.041) in EQ-5D-5L from before to immediately after the intervention with minor additional improvements at 12 months. Despite that individuals with comorbidities had worse baseline scores in all outcomes than individuals without comorbidities, they had similar levels of improvement immediately and 12 months after the intervention. CONCLUSION: Comorbidities are not associated with worse nor better health outcomes following an 8-week exercise and education program in individuals with OA, suggesting exercise as a viable treatment option for individuals with OA, irrespective of comorbidities.

Comparison of the Radiologic, Arthroscopic, and Clinical Outcomes between Repaired versus Unrepaired Medial Meniscus Posterior Horn Root Tear During Open Wedge High Tibial Osteotomy.

The efficacy and outcomes for the concurrent repair of medial meniscus posterior horn root tear (MMPHRT) during open wedge high tibial osteotomy (OWHTO) are unclear. This study compared the radiologic, arthroscopic, and clinical outcomes between repaired and unrepaired MMPHRT during OWHTO. Fifty-seven patients were prospectively enrolled from 2014 to 2016. The radiologic, arthroscopic, and clinical outcomes were compared between 25 patients who underwent OWHTO with all-inside repair of MMPRT using FasT-Fix (repaired group) and 32 patients who underwent OWHTO without repair of MMPRT (unrepaired group) with a mean 2-year follow up in both groups. The meniscal healing status was classified as complete, partial, or no healing, according to second-look arthroscopic findings. The medial meniscal extrusion (MME) was evaluated using magnetic resonance imaging. The width of medial joint space, joint line convergence angle (JLCA), posterior tibial slope (PTS), Kellgren-Lawrence (KL) grade, hip-knee-ankle angle, and weight-bearing line ratio was evaluated on simple standing. The clinical outcomes were evaluated using the Knee Society score and the Western Ontario and McMaster University score. Healing rates (partial and complete) of the MMPHRT showed a statistical difference between the two groups (repaired group vs. unrepaired group, 19/25 (76%) vs. 13/32 (40.6%), p = 0.008). The postoperative MME showed no statistical differences between groups (repaired versus unrepaired group: 4.5 ± 1.3 mm vs. 4.5 ± 2.1 mm, p = 0.909). The postoperative width of medial joint space, JLCA, PTS, and KL grade all showed no statistical differences between groups after 2 years of OWHTO. Other radiologic parameters and clinical outcomes showed no statistical differences between groups. Repair of the MMPHRT during OWHTO showed a superior healing rate to the unrepaired MMPHRT. However, repair of the MMPHRT was not related to the radiologic and clinical outcomes. Therefore, there is no clear evidence of the need for the MMPHRT repair during OWHTO.

Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review.

OBJECTIVE: To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS: We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS: Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS: Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.

Robotic-assisted surgery in medial unicompartmental knee arthroplasty: does it improve the precision of the surgery and its clinical outcomes? Systematic review.

There is a high prevalence of knee osteoarthritis that affects only the medial tibiofemoral compartment. In this group of patients with severe disease, the medial unicompartmental knee arthroplasty (UKA) is an excellent choice. However, this technique has a great learning curve due to the lower tolerance of improper positioning and alignment. In this context, the robotic-assisted surgery (RAS) arises as an option to improve the accuracy and secondarily enhance the clinical outcomes related to the UKA. The objective in this study is to determine if there are significant advantages with the use of RAS over conventional surgery (CS). In the systematic review of the literature, classification of the results in three main subjects: (A) precision and alignment; (B) functional results and clinical parameters; (C) survivorship. We found 272 studies, of which 15 meet the inclusion and exclusion criteria. There is mostly described that RAS significantly improves the accuracy in position (80-100% of planned versus performed P < 0.05), alignment (2-3 times less error variance P < 0.05) and selection of the proper size of the implants (69.23% of correct size femoral implants versus 16.67% using CS P < 0.0154). Recently, there is mild evidence about benefits in the early rehabilitation and post-operative pain, but in all studies reviewed, there is no advantages of RAS in the long-term functional evaluation. There is no strong literature that supports a longer survival of the prothesis with RAS, being the longest mean follow-up reported of 29.6 months. RAS is a useful tool in increasing the precision of the medial UKA implant placement. However, there is still a lack of evidence that properly correlates this improvement in accuracy with better clinical, functional and survival results.

Sequential changes in lower extremity function after total knee arthroplasty.

PURPOSE: The effectiveness of total knee arthroplasty (TKA) for recovering ambulation and balance functions has not been investigated in detail. The present study aimed to measure functional changes in the lower limb before and after TKA by measuring ambulation function with the 3 m Timed Up and Go (TUG) test and balance function using one-leg standing time (ST). METHODS: The study included 137 patients (116 women and 21 men) with osteoarthritis of the knee who underwent primary TKA. The mean age of the patients was 74.4 years. The mean postoperative hospital stay for rehabilitation was 23.9 days. The TUG test and ST were performed preoperatively, 2 weeks postoperatively, at discharge, and 3, 6, and 12 months postoperatively. These results from these six measurements were also compared using one-way repeated measures analysis of variance. RESULTS: The TUG test and ST were significantly improved at 3 months after surgery. However, both the TUG test and ST did not improve further from 3 months to 6 months postoperatively or from 6 months to 1 year postoperatively. CONCLUSION: TKA is useful for restoring lower limb function, as both ambulation and balance functions were significantly improved 3 months after surgery. However, no further improvement in ambulation or balance function was recognized beyond 3 months.

Comparison of a Novel Muscle Training Device with Conventional Rehabilitation Training in Motor Dysfunction of Lower Limb Patients: A Pilot Study.

BACKGROUND: Postoperative functional training for fracture or osteoarthritis is mainly focused on functional self-exercise, which aims to recover the function of the lower limbs. PURPOSE: To compare the function and life quality recovery in patients with fracture or arthritis treated with novel muscle training device (NMT) or conventional rehabilitation training (CRT) following surgery. PATIENTS AND METHODS: A total of 32 fracture patients were randomly divided into the NMT or the CRT groups. The evaluation was performed on the first and 7th day after surgery. The outcome measurements included the incidence of foot drop, Deep Vein Thrombosis and pressure ulcers, Hospital for Special Surgery knee score (HSS scores), pain scores for the Visual Analogue Scale (Pain scores for VAS), Zung self-rating anxiety scale (SAS), Pittsburgh sleep quality index (PSQI) and the Barthel Index score. RESULTS: The comparison of the change scores between the two groups indicated significant differences on day 7 following surgery in the Barthel Index score (P<0.01). The Pain scores for VAS between the two groups indicated a significant difference (P<0.05, U=20.0). The HSS scores between the two groups indicated a significant difference (P<0.05, U=19.0). The HSS scores exhibited a highly significant difference in the NMT group (P<0.01). The Mann-Whitney test was used to analyze the various components of the HSS scores. The comparison of the change scores on the function between the two groups indicated a significant difference (P<0.05). The Range of Motion difference between groups exhibited highly significant differences (P<0.01). CONCLUSION: The novel muscle training device positively influenced the decrease in pain score, which resulted in a range increase of knee joint movement and a significant overall improvement in motion.