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1.
Bone Joint J ; 103-B(2): 329-337, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517740

RESUMO

AIMS: A comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA). METHODS: A radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10° of flexion within each type. Secondary outcomes assessed balance at 45° and 90° and bone recuts required to achieve final knee balance within each CPAK type. RESULTS: There was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p < 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p < 0.001). CONCLUSION: CPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies. Cite this article: Bone Joint J 2021;103-B(2):329-337.


Assuntos
Artroplastia do Joelho , Mau Alinhamento Ósseo/classificação , Articulação do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Assistência Perioperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/complicações , Mau Alinhamento Ósseo/diagnóstico , Mau Alinhamento Ósseo/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/fisiopatologia , Equilíbrio Postural , Estudos Prospectivos , Resultado do Tratamento
2.
JAMA ; 325(7): 646-657, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33591346

RESUMO

Importance: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Objective: To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis. Design, Setting, and Participants: Assessor-blinded randomized clinical trial conducted at a university research center in North Carolina that included 377 community-dwelling adults (≥50 years) with body mass index (BMI) ranging from 20 to 45 and with knee pain and radiographic knee osteoarthritis. Enrollment occurred between July 2012 and February 2016, and follow-up was completed September 2017. Interventions: Participants were randomized to high-intensity strength training (n = 127), low-intensity strength training (n = 126), or attention control (n = 124). Main Outcomes and Measures: Primary outcomes at the 18-month follow-up were Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain (0 best-20 worst; minimally clinically important difference [MCID, 2]) and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking (MCID, unknown). Results: Among 377 randomized participants (mean age, 65 years; 151 women [40%]), 320 (85%) completed the trial. Mean adjusted (sex, baseline BMI, baseline outcome values) WOMAC pain scores at the 18-month follow-up were not statistically significantly different between the high-intensity group and the control group (5.1 vs 4.9; adjusted difference, 0.2; 95% CI, -0.6 to 1.1; P = .61) or between the high-intensity and low-intensity groups (5.1 vs 4.4; adjusted difference, 0.7; 95% CI, -0.1 to 1.6; P = .08). Mean knee joint compressive forces were not statistically significantly different between the high-intensity group and the control group (2453 N vs 2512 N; adjusted difference, -58; 95% CI, -282 to 165 N; P = .61), or between the high-intensity and low-intensity groups (2453 N vs 2475 N; adjusted difference, -21; 95% CI, -235 to 193 N; P = .85). There were 87 nonserious adverse events (high-intensity, 53; low-intensity, 30; control, 4) and 13 serious adverse events unrelated to the study (high-intensity, 5; low-intensity, 3; control, 5). Conclusions and Relevance: Among patients with knee osteoarthritis, high-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months. The findings do not support the use of high-intensity strength training over low-intensity strength training or an attention control in adults with knee osteoarthritis. Trial Registration: ClinicalTrials.gov Identifier: NCT01489462.


Assuntos
Articulação do Joelho/fisiologia , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Treinamento de Resistência/métodos , Idoso , Índice de Massa Corporal , Força Compressiva , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Dor/etiologia , Dor/reabilitação , Medição da Dor , Método Simples-Cego
4.
Medicine (Baltimore) ; 100(1): e24115, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429780

RESUMO

BACKGROUND: Knee osteoarthritis (KOA), also known as degenerative osteoarthritis, is a common and frequently occurring disease in orthopedics with cartilage degeneration as the pathogenic cause and articular bone hyperplasia as the sign. Many studies have confirmed that KOA can be effectively treated by traditional Chinese medicine (TCM) external treatment. So we take advantage of the method of network meta-analysis to systematically compare the efficacy and safety of different types of TCM external treatment for the KOA. METHODS: We will research on external treatment of KOA by traditional Chinese medicine using randomized controlled trials (RCTs) in search database (EMBASE, PubMed, Web of Science, Chinese National Knowledge Infrastructure [CNKI], Weipu database [VIP], Wanfang, and China BioMedical Literature [CBM]). The data and evidence obtained will be processed using Stata 15.0 and WinBUGS 1.4.3. RESULTS: We will evaluate the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis in this study. CONCLUSION: This study will provide a new regimen for KOA treatment. It has extremely high reference value. INPLASY REGISTRATION NUMBER: INPLASY2020120001. DOI NUMBER: : 10.37766/inplasy2020.12.0001.


Assuntos
Protocolos Clínicos , Medicina Tradicional Chinesa/normas , Osteoartrite do Joelho/tratamento farmacológico , Humanos , Medicina Tradicional Chinesa/métodos , Metanálise como Assunto , Osteoartrite do Joelho/complicações , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
Med Clin North Am ; 105(1): 117-136, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246514

RESUMO

Knee pain is present in up to 20% of the adult general population and can be significantly debilitating to patients. A thorough history and physical examination can help localize the source of inflammation or injury to further determine if imaging, physical therapy, specialty referral, or surgery is necessary. By following a systematic approach to evaluating knee pain, primary care physicians can make the correct diagnosis and formulate an appropriate therapeutic strategy for patients.


Assuntos
Assistência Ambulatorial , Artralgia/etiologia , Artralgia/terapia , Adulto , Idoso , Artralgia/classificação , Artralgia/diagnóstico , Tratamento Conservador , Diagnóstico Diferencial , Diagnóstico por Imagem , Terapia por Exercício , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Exame Físico , Perda de Peso , Adulto Jovem
6.
Medicine (Baltimore) ; 99(52): e23470, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350730

RESUMO

ABSTRACT: To assess diagnostic criteria and currently used tools for the identification of central sensitization (CS) in patients with joint pain due to osteoarthritis (OA).Qualitative, cross-sectional and multicenter study based on a 2-round Delphi surveyPublic and private medical centers attending patients with joint pain.A total of 113 specialists in traumatology, physical medicine and rehabilitation, pain management, rheumatology, primary care physicians and geriatrics were enrolled in the study.Participants completed an ad-hoc 26-item questionnaire available from a microsite in Internet.The questionnaire was divided into 6 sections with general data on CS, impact of CS in patients with knee osteoarthritis (KOA), diagnostic criteria for CS, non-pharmacological and pharmacological treatment of CS and usefulness of the concept of CS in the integral management of patients with KOA. Consensus was defined as 75% agreement.Diagnostic criteria included pain of disproportionate intensity to the radiological joint lesion (agreement 86.7%), poor response to usual analgesics (85.8%), progression of pain outside the site of the lesion (76.1%) and concurrent anxiety and depression (76.1%). Based on the opinion of the specialists, about 61% of patients with KOA present moderate-to-severe pain, 50% of them show poor response to conventional analgesics, and 40% poor clinical-radiological correlation. Patients with KOA and CS showed higher functional disability and impairment of quality of life than those without CS (88.5%) and have a poor prognosis of medical, rehabilitation and surgical treatment (86.7%). Early diagnosis and treatment of CS may preserve function and quality of life during all steps of the disease (90.3%).The management of patients with osteoarthritis pain and CS requires the consideration of the intensity of pain related to the joint lesion, response to analgesics, progression of pain to other areas and concurrent anxiety and depression to establish an adequate therapeutic approach based on diagnostic criteria of CS.


Assuntos
Artralgia/diagnóstico , Artralgia/fisiopatologia , Sensibilização do Sistema Nervoso Central , Osteoartrite do Joelho/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Artralgia/etiologia , Estudos Transversais , Técnica Delfos , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Medição da Dor
7.
Medicine (Baltimore) ; 99(30): e21184, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791693

RESUMO

BACKGROUND: Degenerative knee osteoarthritis (KOA) shows an increase in morbidity with improvement in the living conditions and extended lifespans. Treatment for degenerative KOA has been gaining attention since it significantly affects the life of the elderly population and is also associated with increased expenses for medical services and high socioeconomic costs. Treatments for degenerative KOA include nondrug therapy, drug therapy, and surgical treatment. For cases that show little response to conservative treatment but have not involved severe deformation of the knee, procedures such as arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation can be performed. However, effective treatment is required for patients experiencing sustained knee pain after surgery. Although studies confirming the therapeutic effects of acupuncture or thread-embedding acupuncture (TEA) treatment for degenerative KOA have been reported, clinical studies on a combination of TEA and electroacupuncture (EA) in patients complaining of knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation have not yet been reported. Therefore, this study aimed to evaluate the effectiveness and safety of this combination treatment in patients with persistent knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation. METHODS/DESIGN: This study has been designed as a 2-group, parallel, single-center, randomized, controlled, assessor-blinded trial. Thirty-six patients with degenerative KOA who complained of pain even after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation will be randomized to either the (TEA + EA + Usual care) group or the (Usual care only) group in a 1:1 ratio. The patients in the (TEA + EA + Usual care) group will receive TEA treatment once a week for 4 weeks for a total of 4 sessions and EA twice a week for a total of 8 sessions while continuing usual care. The (Usual care only) group will only receive usual care for 4 weeks. To assess the efficacy of the TEA and EA combination treatment, the visual analogue scale, the Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index, the EuroQol 5-Dimension 5-Level, and the doses of the rescue drug taken will be evaluated at baseline (1W) and weeks 2 (2W), 4 (4W), 6 (6W), and 8 (8W). The primary efficacy endpoint is the mean change in visual analogue scale at week 4 (4W) compared to baseline. Adverse events will be assessed at every visit. DISCUSSION: This study will provide useful data for evaluating the clinical efficacy and safety of TEA and electroacupuncture combination treatment for improving pain and quality of life after surgery for degenerative KOA. TRIAL REGISTRATION: Clinical Research Information Service of Republic of Korea (CRIS- KCT0004804), March 6, 2020.


Assuntos
Terapia por Acupuntura/métodos , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/terapia , Polidioxanona/administração & dosagem , Artroscopia , Transplante Ósseo , Cartilagem/transplante , Condrócitos/transplante , Terapia Combinada , Eletroacupuntura , Humanos , Dor Musculoesquelética/etiologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Medição da Dor , Projetos Piloto , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Método Simples-Cego
8.
Khirurgiia (Mosk) ; (7): 76-81, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736467

RESUMO

OBJECTIVE: To evaluate symptom-modifying effects of a two-month parenteral therapy with chondroitin sulfate («Mucosat¼) in patients with knee and/or hip osteoarthritis (OA) in various combinations of adjuvant therapy. MATERIAL AND METHODS: There were 70 patients with primary and/or post-traumatic unilateral/bilateral knee and/or hip osteoarthritis (Kellgren-Lawrence grade I-II). Pain syndrome severity was assessed as ≥ 50 mm (100-mm VAS), total Leken's index - ≥ 5 points. The main group comprised 40 patients who received Mucosat for 60 days. NSAIDs were additionally prescribed in 9 (22.5%) of these patients. The control group included 30 patients with intra-articular injection of hyaluronic acid. All patients underwent clinical and functional examination (rating scales VAS, Leken's total index, WOMAC index, EQ-5D health questionnaire), laboratory diagnosis (IL-1, IL-6, TNF-α), X-ray examination, assessment of adverse events at 5 visits. RESULTS AND CONCLUSION: Administration of chondroitin sulfate is associated with reduced local pain syndrome and functional normalization of musculoskeletal system. Prolonged pain-free period with high safety profile due to reduced need for NSAIDs is an advantage of Mucosat therapy. Thus, this drug may be recommended for initial therapy. A combination of chondroitin sulfate with intra-articular injection of hyaluronic acid may be perspective for optimization of therapy and secondary prevention of exacerbations of OA. Further research is required.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Ácido Hialurônico/uso terapêutico , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Substâncias Protetoras/uso terapêutico , Artralgia/tratamento farmacológico , Artralgia/etiologia , Sulfatos de Condroitina/administração & dosagem , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Osteoartrite do Quadril/complicações , Osteoartrite do Joelho/complicações , Substâncias Protetoras/administração & dosagem , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(28): e21131, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664142

RESUMO

INTRODUCTION: Tumor necrosis factor alpha (TNF-α) mediated inflammation has been implicated, in knee osteoarthritis, despite being a predominantly degenerative condition. PATIENT CONCERNS: A 56-year old female, a case of left knee pain not responding to conventional conservative strategies. DIAGNOSIS: A diagnosis of primary osteoarthritis of the left knee, grade 3 osteoarthritis as per the Kellgren-Lawrence Scale was established. INTERVENTIONS: She was administered an intra-articular injection of 10 mg of Adalimumab, a commonly used anti-TNF agent. OUTCOMES: The patient was evaluated at baseline, 1 month, 3 months, and at 6 months. There was a marked improvement in pain intensity (visual analog scale) and quality of life, despite no objective change on the parameters seen on ultrasound of the knee. CONCLUSION: Injection of adalimumab via the intra-articular route into the knee joint in primary osteoarthritis yields promising results.


Assuntos
Adalimumab/administração & dosagem , Artralgia/diagnóstico , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor/métodos , Antirreumáticos/administração & dosagem , Artralgia/tratamento farmacológico , Artralgia/etiologia , Feminino , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores
10.
Bone Joint J ; 102-B(6): 716-726, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475247

RESUMO

AIMS: This study aims to determine the proportion of patients with end-stage knee osteoarthritis (OA) possibly suitable for partial (PKA) or combined partial knee arthroplasty (CPKA) according to patterns of full-thickness cartilage loss and anterior cruciate ligament (ACL) status. METHODS: A cross-sectional analysis of 300 consecutive patients (mean age 69 years (SD 9.5, 44 to 91), mean body mass index (BMI) 30.6 (SD 5.5, 20 to 53), 178 female (59.3%)) undergoing total knee arthroplasty (TKA) for Kellgren-Lawrence grade ≥ 3 knee OA was conducted. The point of maximal tibial bone loss on preoperative lateral radiographs was determined as a percentage of the tibial diameter. At surgery, Lachman's test and ACL status were recorded. The presence of full-thickness cartilage loss within 16 articular surface regions (two patella, eight femoral, six tibial) was recorded. RESULTS: According to articular cartilage loss and ACL status, 195/293 (67%) were suitable for PKA or CPKA: medial unicompartmental knee arthroplasty (UKA) 97/293 (33%); lateral UKA 25 (9%); medial bicompartmental arthroplasty 31 (11%); lateral bicompartmental arthroplasty 12 (4%); bicondylar-UKA 23 (8%); and patellofemoral arthroplasty (PFA) seven (2%). The ACL was intact in 166 (55%), frayed in 82 (27%), disrupted in 12 (4%), and absent in 33 (11%). Lachman testing was specific (97%) but poorly sensitive (38%) for disrupted/absent ACLs. The point of maximal tibial bone loss showed good interclass correlation (ICC 0.797, 0.73 to 0.85 95% confidence interval (CI); p < 0.001) and was more posterior when the ACL was absent. Maximum tibial bone loss occurring at > 55% of the anterior to posterior distance predicted ACL absence with 93% sensitivity and 91% specificity (area under the curve 0.97 (0.94 to 0.99 95% CI; p < 0.001). CONCLUSION: ACL status can be reliably determined from a lateral radiograph using the location of maximal tibial bone loss. According to regions of cartilage loss and ACL status, two-thirds of patients with end-stage knee OA could potentially be treated with PKA or CPKA. Cite this article: Bone Joint J 2020;102-B(6):716-726.


Assuntos
Ligamento Cruzado Anterior/patologia , Artroplastia do Joelho , Cartilagem Articular/patologia , Osteoartrite do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligamento Cruzado Anterior/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Índice de Gravidade de Doença
11.
Bone Joint J ; 102-B(6_Supple_A): 49-58, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475289

RESUMO

AIMS: The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA). METHODS: A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as 'aligned' if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and 'balanced' if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other. RESULTS: Of 50 knees (10%) with no soft tissue releases (other than cruciate ligaments), 90% were aligned, 81% were balanced, and 73% were aligned and balanced. In 288 knees (59%) only osteophyte excision was performed by subperiosteally releasing the deep medial collateral ligament. Of these, 98% were aligned, 80% were balanced, and 79% were aligned and balanced. In 154 knees (31%), additional procedures were performed (reduction osteotomy, posterior capsular release, and semimembranosus release). Of these, 89% were aligned, 68% were balanced, and 66% were aligned and balanced. The superficial medial collateral ligament was not released in any case. CONCLUSION: Two-thirds of all knees could be aligned and balanced with release of the cruciate ligaments alone and excision of osteophytes. Excision of osteophytes can be a useful step towards achieving deformity correction and gap balance without having to resort to soft tissue release in varus knees while maintaining classical coronal and sagittal alignment of components. Cite this article: Bone Joint J 2020;102-B(6 Supple A):49-58.


Assuntos
Artroplastia do Joelho/métodos , Genu Varum/cirurgia , Osteoartrite do Joelho/cirurgia , Osteófito/cirurgia , Amplitude de Movimento Articular , Cirurgia Assistida por Computador , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteófito/complicações , Estudos Prospectivos
12.
Knee ; 27(3): 740-746, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563431

RESUMO

Knee osteoarthritis in patients with achondroplasia is rare. Bowleg deformity is typical but corrective surgery is limited. Thus, primary total knee arthroplasty (TKA) might be challenging due to the particular anatomy. We report on a patient with 11 year's follow-up after a TKA performed maintaining bowleg alignment, using a posterior stabilized, fixed-bearing design. Sequential X-rays showed radiolucencies on the femoral component within two years postoperatively, slightly increasing over time but stable at last follow-up. The Oxford Knee Score showed an excellent result at 11 years. Despite the peculiarities of a case report, TKA without concomitant osteotomies might be an option for such patients. Nevertheless, a thorough discussion about pros and cons is paramount.


Assuntos
Acondroplasia/cirurgia , Artroplastia do Joelho/métodos , Genu Varum/complicações , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Acondroplasia/complicações , Acondroplasia/diagnóstico , Idoso , Fêmur/cirurgia , Seguimentos , Genu Varum/diagnóstico , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Período Pós-Operatório , Radiografia
13.
Medicine (Baltimore) ; 99(24): e20659, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541508

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common progressive joint disorder in old people. Bushen huoxue (BSHX) is a classical method of TCM in treating KOA. However, there is no systematic review related to BSHX for KOA. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSHX in the treatment of KOA. METHODS: We searched relevant studies on BSHX for KOA from the databases of PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database (CNKI), Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The primary outcomes of this review will focus on pain intensity. The meta-analyses will be performed by using the RevMan 5.3. RESULTS: The study will provide a comprehensive evaluation of the efficacy and safety of the BSHX method for patients with KOA. CONCLUSION: The results of this systematic review will provide evidence to judge whether BSHX is an effective intervention for patients with KOA.


Assuntos
Artralgia/tratamento farmacológico , Artralgia/etiologia , Medicamentos de Ervas Chinesas/uso terapêutico , Metanálise como Assunto , Osteoartrite do Joelho/complicações , Fitoterapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Humanos
14.
Medicine (Baltimore) ; 99(24): e20666, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541510

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic disorder of knee and the leading cause of pain in the elderly with an overall prevalence of 50% in people over 60 years of age. This disease is an important factor affecting the quality of life of middle-aged and elderly people, and its main symptom is knee joint pain. Due to the pain, the knee joint activity function is limited, bringing great pain to patients, affecting their quality of life, effective prevention, and treatment of KOA is a modern medical problem. METHODS: The 60 patients who met the inclusion criteria were randomly divided into the treatment group and the control group. In this study, single center, randomized control and equivalent clinical trial were used for treatment. The treatment group received Yuanhu Zhitong dropping pills within 4 weeks, and the control group received diclofenac sodium sustained-release capsule treatment within 4 weeks. The main measures were visual analogue scale (VAS), WOMAC osteoarthritis index score and gastrointestinal symptoms rating scale (GSRS).Secondary measures included biochemical markers and adverse reactions during treatment. RESULT: The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchprojen.aspx) and in peer-reviewed journals or academic conferences. CONCLUSIONS: This study is to assess the efficacy and safety of Yuanhu Zhitong dropping pills for knee osteoarthritis (KOA). REGISTRATION: PROSPERO (registration number ChiCTR1900024712).


Assuntos
Artralgia/tratamento farmacológico , Artralgia/etiologia , Medicamentos de Ervas Chinesas/uso terapêutico , Osteoartrite do Joelho/complicações , Manejo da Dor/métodos , Fitoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Formas de Dosagem , Humanos , Método Simples-Cego
15.
Medicine (Baltimore) ; 99(24): e20689, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541518

RESUMO

BACKGROUND: The reduced range of motion and pain are the most characteristic clinical features of osteoarthritis (OA). Hyaluronic acid (HA), which is one of the infiltrative therapies for OA treatment, and polynucleotides (PNs), which is a DNA-derived macromolecule favored cell growth and collagen production, are an ongoing debate in clinical effectiveness. METHODS: We plan to perform a systematic review and meta-analysis of randomized clinical trial to evaluate efficacy of intra-articular polynucleotides associated with hyaluronic acid versus hyaluronic acid alone in the treatment of knee osteoarthritis. We will search PubMed, EMBASE, Cochrane Library using a comprehensive strategy. The related conference proceedings and reference lists of the included studies will also be checked to identify additional studies. Two reviewers will screen retrieved records, extract information and assess the risk of bias independently. Stata v15.1 software will be used to conduct data synthesis. RESULTS: This study will be submitted to a peer-reviewed journal for publication. CONCLUSION: We hope it will provide a relatively comprehensive reference for clinical practice and future relevant clinical trials. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required, as this study is a systematic review and meta-analysis. PROSPERO REGISTRATION NUMBER: CRD42020167678.


Assuntos
Artralgia/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Metanálise como Assunto , Osteoartrite do Joelho/complicações , Polinucleotídeos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Combinação de Medicamentos , Humanos , Injeções Intra-Articulares , Resultado do Tratamento
16.
Health Qual Life Outcomes ; 18(1): 168, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503548

RESUMO

BACKGROUND: Fatigue is a common symptom associated with a wide range of diseases and needs to be more thoroughly studied. To minimise patient burden and to enhance response rates in research studies, patient-reported outcome measures (PROM) need to be as short as possible, without sacrificing reliability and validity. It is also important to have a generic measure that can be used for comparisons across different patient populations. Thus, the aim of this secondary analysis was to evaluate the psychometric properties of the Norwegian 5-item version of the Lee Fatigue Scale (LFS) in two distinct patient populations. METHODS: The sample was obtained from two different Norwegian studies and included patients 4-6 weeks after stroke (n = 322) and patients with osteoarthritis on a waiting list for total knee arthroplasty (n = 203). Fatigue severity was rated by five items from the Norwegian version of the LFS, rating each item on a numeric rating scale from 1 to 10. Rasch analysis was used to evaluate the psychometric properties of the 5-item scale across the two patient samples. RESULTS: Three of the five LFS items ("tired", "fatigued" and "worn out") showed acceptable internal scale validity as they met the set criterion for goodness-of-fit after removal of two items with unacceptable goodness-of-fit to the Rasch model. The 3-item LFS explained 81.6% of the variance, demonstrated acceptable unidimensionality, could separate the fatigue responses into three distinct severity groups and had no differential functioning with regard to disease group. The 3-item version of the LFS had a higher separation index and better internal consistency reliability than the 5-item version. CONCLUSIONS: A 3-item version of the LFS demonstrated acceptable psychometric properties in two distinct samples of patients, suggesting it may be useful as a brief generic measure of fatigue severity. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02338869; registered 10/04/2014 (stroke study).


Assuntos
Fadiga/classificação , Osteoartrite do Joelho/complicações , Medidas de Resultados Relatados pelo Paciente , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Estudos Transversais , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Psicometria/normas , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
17.
Ann Rheum Dis ; 79(8): 1105-1110, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32381567

RESUMO

OBJECTIVES: Although treatment development in osteoarthritis (OA) focuses on chondroprotection, it is unclear how much preventing cartilage loss reduces joint pain. It is also unclear how nociceptive tissues may be involved. METHODS: Using data from the Osteoarthritis Initiative, we quantified the relation between cartilage loss and worsening knee pain after adjusting for bone marrow lesions (BMLs) and synovitis, and examined how much these factors mediated this association. 600 knee MRIs were scored at baseline, 12 months and 24 months for quantitative and semiquantitative measures of OA structural features. We focused on change in medial cartilage thickness using an amount similar to that seen in recent trials. Linear models calculated mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score with cartilage loss, adjusted for baseline BMLs, synovitis and covariates. Mediation analysis tested whether change in synovitis or BMLs mediated the cartilage loss-pain association. We carried out a subanalysis for knees with non-zero baseline WOMAC pain scores and another for non-valgus knees. RESULTS: Cartilage thickness loss was significantly associated with a small degree of worsening in pain over 24 months. For example, a loss of 0.1 mm of cartilage thickness over 2 years was associated with a 0.32 increase in WOMAC pain (scale 0-20). The association of cartilage thickness loss with pain was mediated by synovitis change but not by BML change. Subanalysis results were similar. CONCLUSIONS: Cartilage thickness loss is associated with only a small amount of worsening knee pain, an association mediated in part by worsening synovitis. Demonstrating that chondroprotection reduces knee pain will be extremely challenging and is perhaps unachievable.


Assuntos
Artralgia/etiologia , Cartilagem Articular/patologia , Osteoartrite do Joelho/patologia , Idoso , Feminino , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações
18.
JAMA ; 323(18): 1802-1812, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32396180

RESUMO

Importance: Individually calibrated biomechanical footwear therapy may improve pain and physical function in people with symptomatic knee osteoarthritis, but the benefits of this therapy are unclear. Objective: To assess the effect of a biomechanical footwear therapy vs control footwear over 24 weeks of follow-up. Design, Setting, and Participants: Randomized clinical trial conducted at a Swiss university hospital. Participants (N = 220) with symptomatic, radiologically confirmed knee osteoarthritis were recruited between April 20, 2015, and January 10, 2017. The last participant visit occurred on August 15, 2017. Interventions: Participants were randomized to biomechanical footwear involving shoes with individually adjustable external convex pods attached to the outsole (n = 111) or to control footwear (n = 109) that had visible outsole pods that were not adjustable and did not create a convex walking surface. Main Outcomes and Measures: The primary outcome was knee pain at 24 weeks of follow-up assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore standardized to range from 0 (no symptoms) to 10 (extreme symptoms). The secondary outcomes included WOMAC physical function and stiffness subscores and the WOMAC global score, all ranging from 0 (no symptoms) to 10 (extreme symptoms) at 24 weeks of follow-up, and serious adverse events. Results: Among the 220 randomized participants (mean age, 65.2 years [SD, 9.3 years]; 104 women [47.3%]), 219 received the allocated treatment and 213 (96.8%) completed follow-up. At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, -1.3 [95% CI, -1.8 to -0.9]; P < .001). The results were consistent for WOMAC physical function subscore (between-group difference, -1.1 [95% CI, -1.5 to -0.7]), WOMAC stiffness subscore (between-group difference, -1.4 [95% CI, -1.9 to -0.9]), and WOMAC global score (between-group difference, -1.2 [95% CI, -1.6 to -0.8]) at 24 weeks of follow-up. Three serious adverse events occurred in the biomechanical footwear group compared with 9 in the control footwear group (2.7% vs 8.3%, respectively); none were related to treatment. Conclusions and Relevance: Among participants with knee pain from osteoarthritis, use of biomechanical footwear compared with control footwear resulted in an improvement in pain at 24 weeks of follow-up that was statistically significant but of uncertain clinical importance. Further research would be needed to assess long-term efficacy and safety, as well as replication, before reaching conclusions about the clinical value of this device. Trial Registration: ClinicalTrials.gov Identifier: NCT02363712.


Assuntos
Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , Manejo da Dor/instrumentação , Sapatos , Adulto , Fenômenos Biomecânicos , Engenharia Biomédica , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Dor/etiologia , Medição da Dor , Qualidade de Vida , Sapatos/efeitos adversos
19.
Pain Res Manag ; 2020: 7587936, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32322326

RESUMO

Objective: The purpose of this meta-analysis was to determine whether platelet-rich plasma (PRP) was better than hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA) in overweight or obese patients. Design: Two reviewers independently used the keywords combined with free words to search English-based electronic databases according to Cochrane Collaboration guidelines, such as PubMed, Embase, ScienceDirect, and Cochrane library. The pooled data were analyzed using RevMan 5.3. Results: Ten randomized controlled trials (RCTs) with 1096 patients were included. During the first two months of follow-up, there was no significant difference between the two groups. At the 3rd, 6th, and 12th months of follow-up, the pooled analysis showed that PRP was better than HA for the treatment of knee OA in overweight or obese patients. There were significant differences between the two groups at Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (3 months: MD = -1.35, [95% CI: -2.19 to -0.50], P=0.002, I 2 = 0%; 6 months: MD = -7.62, [95% CI: -13.51 to -1.72], P=0.01, I 2 = 88%; 12 months: MD = -12.11, [95% CI: -20.21 to -4.01], P=0.003, I 2 = 94%). Conclusions: For overweight or obese patients with knee OA, intra-articular injection of PRP in a short time was not necessarily superior to HA, but long-term use was better than HA in pain and functional relief.


Assuntos
Ácido Hialurônico/uso terapêutico , Obesidade/complicações , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/terapia , Sobrepeso/complicações , Plasma Rico em Plaquetas , Humanos , Injeções Intra-Articulares , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
20.
Sci Rep ; 10(1): 6620, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32313003

RESUMO

Balneotherapy is a common non-pharmacological treatment for osteoarthritis (OA), however, the efficacy is controversial in knee OA. Jeju magma-seawater (JMS) has high contents of various minerals, which has anti-inflammatory and antioxidant properties via an oral route. Thus, we examined the effects of JMS bathing on knee OA and the combination effects with diclofenac sodium as an anti-inflammatory drug. Knee OA was induced by transection of the anterior cruciate ligament and the partial meniscectomy in rat. The rats were administered subcutaneously saline or diclofenac sodium in saline, followed by bathing in thermal distilled water or JMS for 8 weeks. The model represented the characteristic changes of the cartilage degradation, osteophyte formation and synovial inflammation, and the relevant symptoms of the joint swelling and stiffness. However, the JMS bathing reduced the joint thickness and improved the mobility. It also contributed to a well-preserved tissue supported by increases in bone mineral density of the joint and decreases in Mankin scores in the cartilages. The effects involved anti-inflammation, chondroprotection, anti-apoptosis, and chondrogenesis. Overall, the JMS bathing in combination with diclofenac sodium showed a similar trend associated with synergic effects. It suggests that JMS bathing can be promising for a clinical use in knee OA.


Assuntos
Balneologia , Osteoartrite do Joelho/terapia , Água do Mar , Animais , Apoptose , Densidade Óssea , Cartilagem/patologia , Proliferação de Células , Força Compressiva , Modelos Animais de Doenças , Inflamação/complicações , Inflamação/patologia , Mediadores da Inflamação/metabolismo , Articulação do Joelho/patologia , Articulação do Joelho/fisiopatologia , Masculino , Metaloproteinases da Matriz/metabolismo , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/fisiopatologia , Proteólise , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Sprague-Dawley
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