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2.
Tech Vasc Interv Radiol ; 23(4): 100706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308582

RESUMO

Knee osteoarthritis, a chronic degenerative condition, can be a debilitating and limiting process with affected patients presenting with symptoms such as pain, restrictive range of motion, and swelling. This condition commonly afflicts millions of people with a higher incidence among the elderly that results from chronic mechanical repetitive loading. The treatment of pain generating conditions such as arthritis in large joints is complex requiring interventions of varying focuses such as weight loss, anti-inflammatory medications, corticosteroid, hyaluronic and viscosupplementation injections, and prescription opioids. A gap in the treatment options of this ailment currently exists between short term pain solutions and surgical approaches such as total knee arthroplasty that may offer longer pain relief. Cooled radiofrequency ablation is an emerging technique that offers a minimally invasive alternative for treating knee pain with a clinical relevance in patients who are not surgical candidates due to coexistent medical comorbidities or those who are undesiring of surgery. This procedure uses radiofrequency ablation that blocks genicular nerves from transmitting knee pain signals to the brain. Further research will allow the application of this technique to treat other sensory nerves in large joints such as the hip and shoulder.


Assuntos
Artralgia/cirurgia , Denervação , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Denervação/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
3.
PLoS One ; 15(12): e0241117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326434

RESUMO

Deafferentation and weight offloading can increase brain and spinal motor neuron excitability, respectively. End-effector gait robots (EEGRs) can blend these effects with stereotyped movement-induced neuroplasticity. The authors aimed to evaluate the usefulness of EEGRs as a postoperative neuro-muscular rehabilitation tool. This prospective randomized controlled trial included patients who had undergone unilateral total knee arthroplasty (TKA). Patients were randomly allocated into two groups: one using a 200-step rehabilitation program in an EEGR or the other using a walker on a floor (WF) three times a day for five weekdays. The two groups were compared by electrophysiological and biomechanical methods. Since there were no more enrollments due to funding issues, interim analysis was performed. Twelve patients were assigned to the EEGR group and eight patients were assigned to the WF group. Although the muscle volume of the quadriceps and hamstring did not differ between the two groups, the normalized peak torque of the operated knee flexors (11.28 ± 16.04 Nm/kg) was improved in the EEGR group compared to that of the operated knee flexors in the WF group (4.25 ± 14.26 Nm/kg) (p = 0.04). The normalized compound motor action potentials of the vastus medialis (VM) and biceps femoris (BF) were improved in the EEGR group (p < 0.05). However, the normalized real-time peak amplitude and total, mean area under the curve of VM were decreased during rehabilitation in the EEGR group (p < 0.05). No significant differences were found between operated and non-operated knees in the EEGR group. Five-day EEGR-assisted rehabilitation induced strengthening in the knee flexors and the muscular reactivation of the BF and VM after TKA, while reducing the real-time use of the VM. This observation may suggest the feasibility of this technique: EEGR modulated the neuronal system of the patients rather than training their muscles. However, because the study was underpowered, all of the findings should be interpreted with the utmost caution.


Assuntos
Artroplastia do Joelho/reabilitação , Osteoartrite do Joelho/reabilitação , Osteoartrite do Joelho/cirurgia , Robótica/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Terapia por Exercício , Feminino , Marcha , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Movimento , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Robótica/métodos , Método Simples-Cego , Andadores , Suporte de Carga/fisiologia
4.
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
5.
Medicine (Baltimore) ; 99(44): e22853, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126326

RESUMO

BACKGROUND: Knee osteoarthritis (KOA), a concerning public health problem, seriously threatens well being of human beings. At present, studies have shown that massage therapy is effective in relieving related symptoms of KOA. However, the evidence of massage for KOA has not been systematically evaluated. Therefore, the study is conducted to systematically assess the reliability of patients with KOA treated by massage. METHODS: We will retrieve the relevant literature of massage for KOA from PubMed, Cochrane Library, EMBASE, Web of Science, Wanfang, Chongqing VIP, CNKI, and Chinese Biomedical Literature Database from the establishment of the databases to August 1, 2020. Two researchers will independently perform the screening of literature and extract the basic information of the data. In addition, RevMan V.5.3 software will be used for data analysis. RESULTS: The study will comprehensively assess the effect of massage for KOA. CONCLUSION: The study will provide comprehensive evidence for evaluating whether massage therapy is useful in treating patients with KOA. INPLASY REGISTRATION NUMBER: INPLASY202080115.


Assuntos
Massagem/normas , Metanálise como Assunto , Osteoartrite do Joelho/terapia , Protocolos Clínicos , Humanos , Massagem/métodos , Massagem/estatística & dados numéricos , Osteoartrite do Joelho/fisiopatologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
6.
J Vasc Interv Radiol ; 31(9): 1453-1458, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32868019

RESUMO

Ten patients with painful early-stage knee osteoarthritis underwent transcatheter arterial embolization of neoangiogenic branches from genicular arteries. At 12 months, 6 patients had responded to treatment according to study criteria. Median pain, function, and quality-of-life scores had improved by 15.4%, 21.3%, and 100%, respectively, for the 10 patients. Median 30-second chair stand test and 6-minute walk test scores had improved by 43% and 26%, respectively. No major adverse events occurred. Improvements following transcatheter arterial embolization provide evidence that embolization might be an effective treatment technique for people with early-stage knee osteoarthritis, although more rigorous evaluation is required.


Assuntos
Artralgia/terapia , Embolização Terapêutica , Articulação do Joelho/irrigação sanguínea , Neovascularização Patológica , Osteoartrite do Joelho/terapia , Idoso , Artralgia/diagnóstico , Artralgia/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(35): e21749, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871895

RESUMO

BACKGROUND: Osteoarthritis is the most common form of arthritis, and is a major cause of disability and chronic pain in adults. However, there is very limited evidence in the scientific literature to support the effectiveness of extracorporeal shockwave therapy (ESWT) in human knee osteoarthritis. This retrospective study aimed to compare the efficacy of ESWT treatment with sham-ESWT on pain, walking speed, physical function, and adverse effects in knee osteoarthritis. METHODS: This study will be performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We reviewed patients diagnosed with knee osteoarthritis at our academic center from 2016 to 2017. This retrospective cohort study was approved by the institutional review board in Ruijin Hospital. The primary outcome measure was pain on movement measured by a 100-cm visual analog scale. The secondary outcome measures included the Western Ontario and McMaster University Osteoarthritis Index, range of motion, and adverse effects. Statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (IBM Corporation, Armonk, NY). A P-value of <.05 was defined as statistical significance. RESULTS: The hypothesis was that ESWT would be an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5801).


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho/terapia , Terapia por Exercício , Humanos , Articulação do Joelho/fisiopatologia , Estudos Observacionais como Assunto , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Amplitude de Movimento Articular , Projetos de Pesquisa , Estudos Retrospectivos
8.
Sci Data ; 7(1): 290, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32901007

RESUMO

Assessment of human movement performance in activities of daily living (ADL) is a key component in clinical and rehabilitation settings. Motion capture technology is an effective method for objective assessment of human movement. Existing databases capture human movement and ADL performance primarily in the Western population, and there are no Asian databases to date. This is despite the fact that Asian anthropometrics influence movement kinematics and kinetics. This paper details the protocol in the first phase of the largest Asian normative human movement database. Data collection has commenced, and this paper reports 10 healthy participants. Twelve tasks were performed and data was collected using Qualisys motion capture system, force plates and instrumented table and chair. In phase two, human movement of individuals with stroke and knee osteoarthritis will be captured. This can have great potential for benchmarking with the normative human movement captured in phase one and predicting recovery and progression of movement for patients. With individualised progression, it will offer the development of personalised therapy protocols in rehabilitation.


Assuntos
Atividades Cotidianas , Movimento , Grupo com Ancestrais do Continente Asiático , Fenômenos Biomecânicos , Voluntários Saudáveis , Humanos , Osteoartrite do Joelho/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia
10.
Niger J Clin Pract ; 23(7): 934-943, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620722

RESUMO

Aims: This study establishes the reliability and validity of pain pressure threshold (PPT) in evaluating pain for older adults with knee arthritis, and explores the importance of using a standard tool to measure pain in older adults. Methods: The study consisted of a group of 31 older adult patients with bilateral symptomatic knee osteoarthritis, intra- and inter-rater reliability, and concurrent validity that were assessed for PPT and were compared with standard visual analogue scale (VAS). Physical therapy intervention was provided to combat the pain. Results: The PPT showed excellent intra-assessor reliability by not only meeting acceptable standards but also representing very high values. The intra-assessor reliability between test sessions was excellent. The inter-assessor agreement was also very high before treatment. The highest ICC showed very good agreement (0.860) during the initial treatment for pain pressure measurement. The study also established concurrent validity of VAS and PPT (before treatment and after treatment), where the rho correlation was high (-0.708 and -0.625) and significant, indicating that PPT is adequately sensitive for detecting changes over time. Conclusion: PPT is a reliable and valid tool for measuring pain, and it helps clinicians understand the prognostic effect of the intervention, especially in older adults. The tool is consistent at measuring pain and is a valid tool compared to subjective pain scoring.


Assuntos
Osteoartrite do Joelho , Medição da Dor/métodos , Limiar da Dor , Dor , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/fisiopatologia , Medição da Dor/normas , Modalidades de Fisioterapia , Reprodutibilidade dos Testes , Arábia Saudita , Escala Visual Analógica
11.
Orthopade ; 49(7): 617-624, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32494904

RESUMO

BACKGROUND: Despite the growing clinical evidence "pro" kinematic alignment (KA) in primary total knee arthroplasty, the idea of this individualized implant positioning has not (yet) become established throughout the community. Many surgeons have concerns about the safety of the method and the universality of its application. Interestingly, comparative studies with unlimited indications for KA showed only little or no advantage over standard mechanical alignment in contrast to studies with strict indications showing a significant benefit. QUESTION AND METHODOLOGY: This results in a discussion about possible indication limits for KA. The aim of this article is to summarize the current evidence and theoretical considerations regarding ideal and possibly non-ideal patients. Furthermore, the paper describes the "lessons learned" of the past years as a recommendation for safe use of the method. RESULTS AND DISCUSSION: Based on current evidence, primary varus osteoarthritis appears to be a good indication for KA. A limitation, however, is extra-articular deformities that lead to a pathologically joint line angle. Instabilities of the collateral ligaments are to be considered as a contraindication. In contrast to varus type osteoarthritis, valgus deformities appear to be more critical for KA. Even though there is yet only limited evidence, especially the accompanying extra-articular pathologies of the hip and ankle pose an increased risk of failure. In our opinion, a restricted KA with an individualized component position but neutral overall limb alignment makes sense here. To analyze the suitability of KA and estimate the post-operative component position, weight-bearing long-leg x­rays are recommended. Additional stress radiography is helpful in certain cases, as is the three-dimensional analysis of the anatomy by CT or MRI scans.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Articulação do Tornozelo/patologia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/patologia , Osteoartrite do Joelho/fisiopatologia , Suporte de Carga
12.
Zhonghua Wai Ke Za Zhi ; 58(6): 457-463, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498486

RESUMO

Objective: To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI). Methods: The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results: The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° (t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative (t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative (t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) (M(Q(R))) preoperative to 5.5 (5.25) postoperative (Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions: PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/etiologia , Mau Alinhamento Ósseo/prevenção & controle , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Modelagem Computacional Específica para o Paciente , Estudos Retrospectivos , Cirurgia Assistida por Computador
13.
Knee ; 27(3): 717-722, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563428

RESUMO

BACKGROUND: Sensor-guided compartmental pressure measurements are becoming increasingly utilized in total knee arthroplasty (TKA) to objectively confirm intraoperative knee balance. We aimed to determine agreement of pressure measurements between two observers when performing sensor-guided TKA with the use of computer-assisted surgery (CAS). METHODS: One-hundred and eighteen consecutive patients undergoing 130 TKAs were analysed. Femoral and tibial trial implants were inserted prior to performing knee balancing. We compared the reliability of sensor pressure compartmental measurements between two observers at 10, 45 and 90° of flexion using intraclass correlation coefficient (ICC) estimates and the 95% limits of agreement (Bland-Altman plots). RESULTS: The interobserver agreement between sensor pressure measurements was excellent at 10° of knee flexion, with ICCs of 0.93 and 0.91 in the medial and lateral compartments, respectively (P < 0.001). At 45°, medial and lateral compartment ICCs were 0.91 and 0.76, respectively (P < 0.001). At 90°, the ICC was 0.88 medially and 0.76 laterally (P < 0.001). Although the agreement decreased at higher knee flexion, it remained good to excellent. The 95% limits of agreement at each angle were all within 20 psi and 11 psi for the medial and lateral compartments, respectively. CONCLUSIONS: There was excellent interobserver agreement of sensor pressure measurements at 10° of knee flexion with computer-assisted TKA. Interobserver agreement decreased slightly as knee flexion angles increased, particularly in the lateral compartment. It is likely that interobserver agreement and hence reliability of sensor pressure measurements in TKA has some dependence on accurate angular positioning of the knee.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular/fisiologia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Pressão , Curva ROC , Reprodutibilidade dos Testes
14.
Medicine (Baltimore) ; 99(22): e20171, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481382

RESUMO

OBJECTIVE: The aim of this systematic review and meta-analysis is to assess the efficacy of acupuncture and moxibustion in pain relief and quality of life improvement of knee osteoarthritis (KOA) patients. METHODS: The following databases will be searched: MEDLINE, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese Nation Knowledge Infrastructure, Wanfang Database, the Chongqing VIP from inception to May 1, 2020. All randomized controlled trials (RCTs) used acupuncture or moxibustion to relieve pain and improve quality of life (QoL) among KOA patients will be included. Study selection, data extraction, quality assessment and assessment of risk bias will be performed by 2 reviewers independently. Data synthesis will be performed using Review Manager V5.3 software. A meta-analysis will be performed when there is sufficient available data. PROSPERO REGISTRATION NUMBER: CRD42020169724.


Assuntos
Terapia por Acupuntura , Moxibustão , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Qualidade de Vida , Humanos , Metanálise como Assunto , Osteoartrite do Joelho/fisiopatologia , Revisões Sistemáticas como Assunto
15.
PLoS One ; 15(5): e0232513, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407415

RESUMO

BACKGROUND: The unipodal stance task is a clinical task that quantifies postural stability and alignment of the lower limb joints, while weight bearing on one leg. As persons with knee osteoarthritis (KOA) have poor postural and knee joint stability, objective assessment of this task might be useful. OBJECTIVE: To investigate the discriminant validity of three-dimensional joint kinematics and centre of mass displacement (COM) between healthy controls and persons with knee KOA, during unipodal stance using inertial sensors. Additionally, the reliability, agreement and construct validity are assessed to determine the reproducibility and accuracy of the discriminating parameters. METHODS: Twenty healthy controls and 19 persons with unilateral severe KOA were included. Five repetitions of the unipodal stance task were simultaneously recorded by an inertial sensor system and a camera-based system (gold standard). Statistical significant differences in kinematic waveforms between healthy controls and persons with severe knee KOA were determined using one-dimensional statistical parametric mapping (SPM1D). RESULTS: Persons with severe knee KOA had more lateral trunk lean towards the contralateral leg, more hip flexion throughout the performance of the unipodal stance task, more pelvic obliquity and COM displacement towards the contralateral side. However, for the latter two parameters the minimum detectable change was greater than the difference between healthy controls and persons with severe knee KOA. The construct validity was good (coefficient of multiple correlation 0.75, 0.83 respectively) and the root mean squared error (RMSE) was low (RMSE <1.5°) for the discriminant parameters. CONCLUSION: Inertial sensor based movement analysis can discriminate between healthy controls and persons with severe knee KOA for lateral trunk lean and hip flexion, but unfortunately not for the knee angles. Further research is required to improve the reproducibility and accuracy of the inertial sensor measurements before they can be used to assess differences in tasks with a small range of motion.


Assuntos
Articulação do Joelho/fisiologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Imageamento Tridimensional , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiologia , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Amplitude de Movimento Articular/fisiologia , Tecnologia de Sensoriamento Remoto , Reprodutibilidade dos Testes
16.
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
17.
JAMA Netw Open ; 3(5): e204049, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32364594

RESUMO

Importance: Persons with knee symptoms recognize the health benefits of engaging in physical activity, but uncertainty persists about whether regular strenuous physical activity or exercise can accelerate tissue damage. A sedentary lifestyle of inactivity or underloading may also be associated with deleterious joint health. Objective: To establish whether long-term strenuous physical activity participation and extensive sitting behavior are each associated with increased risk of developing radiographic knee osteoarthritis (KOA) in individuals at high risk for the disease. Design, Setting, and Participants: This cohort study analyzed data from the Osteoarthritis Initiative, a prospective longitudinal cohort study of men and women with or at an increased risk of developing symptomatic, radiographic KOA. Community-dwelling adults were recruited from 4 US sites (Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island) and were followed up for up to 10 years. Individuals were included if they had a baseline Kellgren and Lawrence grade of 0 in both knees and completed a PASE (Physical Activity Scale for the Elderly) questionnaire at baseline and at least 2 follow-up visits over an 8-year interval. Data analyses were conducted from May 2018 to November 2018. Exposures: Baseline to 8-year trajectories of strenuous physical activity participation and extensive sitting behavior were identified using group-based trajectory models. Main Outcomes and Measures: Incident radiographic KOA, defined as Kellgren and Lawrence grade 2 or higher in either knee by the 10-year follow-up visit. Results: A total of 1194 participants were included in the sample (697 women [58.4%]), with a baseline mean (SD) age of 58.4 (8.9) years and mean body mass index (BMI) of 26.8 (4.5). Four distinct trajectories of weekly hours spent in strenuous physical activities and 3 distinct trajectories of extensive sitting were identified. Long-term engagement in low-to-moderate physical activities (adjusted odds ratio [OR], 0.69; 95% CI, 0.48-1.01) or any strenuous physical activities (adjusted OR, 0.75; 95% CI, 0.53-1.07) was not associated with 10-year incident radiographic KOA. Persistent extensive sitting was not associated with incident KOA. Despite relatively mild symptoms and high function in this early-stage sample, 594 participants (49.7%) did not engage in any strenuous physical activities (ie, 0 h/wk) across 8 years, and 507 (42.5%) engaged in persistent moderate-to-high frequency of extensive sitting. Older age, higher BMI, more severe knee pain, non-college graduate educational level, weaker quadriceps, and depression were each associated with a persistent lack of engagement in strenuous physical activities. Conclusions and Relevance: Results from this study appeared to show no association between long-term strenuous physical activity participation and incident radiographic KOA. The findings raise the possibility of a protective association between incident KOA and a low-to-moderate level of strenuous physical activities.


Assuntos
Exercício Físico , Osteoartrite do Joelho/epidemiologia , Postura Sentada , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
18.
Am J Sports Med ; 48(7): 1711-1719, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374673

RESUMO

BACKGROUND: Patellofemoral joint (PFJ) osteoarthritis may occur after anterior cruciate ligament reconstruction (ACLR). The mechanisms underpinning the development of PFJ osteoarthritis are not known but may relate to altered PFJ loading. Few studies have assessed PFJ loads during high-impact tasks, such as running, beyond the acute rehabilitation phase (ie, >12 months) after ACLR. PURPOSE/HYPOTHESIS: The purpose was to compare between-limb joint angles, joint moments, and PFJ contact force during running in individuals at 12 to 24 months after unilateral ACLR. We hypothesized that peak knee flexion angle, knee extension moment, and PFJ contact force during stance would be lower in the ACLR limb compared with the uninjured limb. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 55 participants (mean ± SD age, 28 ± 7 years), 12 to 24 months after ACLR, ran at a self-selected speed (2.9 ± 0.3 m/s). Measured kinematics and ground-reaction forces were input into musculoskeletal models to calculate joint moments and muscle forces. These values were subsequently input into a PFJ model to calculate contact force peak and impulse. Outcome measures were compared between the ACLR and uninjured limbs. RESULTS: In the ACLR limb, compared with the uninjured limb, the PFJ contact force displayed a lower peak (ACLR, 6.1 ± 1.3 body weight [BW]; uninjured, 6.7 ± 1.4 BW; P < .001) and impulse (ACLR, 0.72 ± 0.17 BW*seconds [BWs]; uninjured, 0.81 ± 0.17 BWs; P < .001). At the time of the peak PFJ contact force, the knee extension moment was lower in the ACLR limb (ACLR, 14.0 ± 2.4 %BW*height [%BW*HT]; uninjured, 15.5 ± 2.5 %BW*HT; P < .001). The opposite was true for the ankle plantarflexion moment (ACLR, 12.1 ± 2.6 %BW*HT; uninjured, 11.5 ± 2.7 %BW*HT; P = .019) and the hip extension moment (ACLR, 2.3 ± 2.5 %BW*HT; uninjured, 1.6 ± 2.3 %BW*HT; P = .013). The foot-ground center of pressure was located more anteriorly with respect to the ankle joint center (ACLR, 5.8 ± 0.9 %height [%HT]; uninjured, 5.4 ± 1.0 %HT; P = .001). No differences were found for the sagittal plane hip, knee, and ankle angles. CONCLUSION: The ACLR limb experienced lower peak PFJ loads during running, explained by a small anterior shift in the foot-ground center of pressure during stance that offloaded the torque demand away from the ACLR knee. CLINICAL RELEVANCE: Lower net PFJ loading during running in the ACLR limb more than 12 months after ACLR suggests that underloading might play a role in the onset of PFJ osteoarthritis after ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Articulação Patelofemoral/fisiologia , Corrida/fisiologia , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior/métodos , Fenômenos Biomecânicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/fisiopatologia , Torque , Suporte de Carga/fisiologia , Adulto Jovem
19.
Sci Rep ; 10(1): 7294, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32350320

RESUMO

This study aimed to examine the effect of transcutaneous electrical nerve stimulation (TENS) on stair climbing capacity in individuals with pre-radiographic to mild knee osteoarthritis (OA). This is a secondary analysis of data from a single, participant-blinded, randomized controlled trial with a pre-post design. Participants with pre-radiographic to mild knee OA (mean age, 59.1 years; 72.9% women) were randomly assigned into two groups, a TENS (n = 30) and a sham-TENS groups (n = 29). TENS or sham-TENS treatments were applied to all participants by using the prototype TENS device with pre-specified parameters. The primary outcome measures included valid and reliable functional measures for stair climbing (stair-climb test [SCT]), visual analog scale for knee pain during the SCT, and quadriceps muscle strength. TENS improved SCT time by 0.41 s (95% confidence interval [CI]: 0.07, 0.75). The time reduction in the transition phase explains the TENS therapeutic effect. Post-hoc correlation analyses revealed a non-significant but positive relationship between the pain relief effect and improved 11-step SCT time in the TENS group but not in the sham-TENS group. These results indicate that the TENS intervention may be an option for reducing the burden of early-stage knee OA.


Assuntos
Força Muscular , Osteoartrite do Joelho , Músculo Quadríceps/fisiopatologia , Subida de Escada , Estimulação Elétrica Nervosa Transcutânea , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia
20.
Sci Rep ; 10(1): 8444, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439881

RESUMO

This study aimed to elucidate the relationship between the quantitative value of suprapatellar effusion and the longitudinal changes in lower-extremity muscle mass (MM) in a cohort with knee osteoarthritis (KOA). Fifty-three subjects (106 legs) with bilateral radiographic KOA at baseline (BL) were enrolled. MM was calculated by bioimpedance analysis three times at BL, and at the one-year (1Y) and three-year (3Y) follow-ups. The longitudinal change in the lower-extremity MM was calculated by subtracting MMBL from MM1Y, and MM1Y from MM3Y. Subjects with ≥1.0 z-score loss were defined as having severe MM loss (SMML). Effusion was evaluated as the sagittal area of suprapatellar pouch (mm2) by ultrasonography. The ROC curve was drawn to determine the cut-off of effusion area. General estimating equations (GEEs) were conducted with the prevalence of SMML as the dependent variable and with the cut-off of effusion area as the independent variable. Sixteen legs (15.1%) demonstrated SMMLBL-1Y and another sixteen legs demonstrated SMML1Y-3Y. GEEs revealed that individuals with ≥90 mm2 effusion had significantly higher odds of SMMLBL-1Y prevalence (Odds ratio: 21.561; P-value: 0.003). Individuals with leachate knee effusion at BL had a significant risk of losing MM through the first year of the initial knee effusion assessment.


Assuntos
Exsudatos e Transudatos/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Atrofia Muscular/diagnóstico , Atrofia Muscular/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Líquido Sinovial/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Impedância Elétrica , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Articulação do Joelho/diagnóstico por imagem , Estudos Longitudinais , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
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