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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1527-1531, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823552

RESUMO

Objective: To investigate the effectiveness of extracorporeal shock wave therapy combined with platelet-rich plasma (PRP) injection in treatment of knee osteoarthritis (KOA) by prospective clinical study. Methods: Between June 2015 and June 2018, 180 patients with KOA met the inclusion criteria were included in study and randomly allocated to group A (n=60), group B (n=60), and group C (n=60). The patients were treated with autologous PRP intra-articular injection in group A, extracorporeal shock wave therapy in group B, and extracorporeal shock wave therapy combined with autologous PRP intra-articular injection in group C, once a week and 5 times a duration of treatment. There was no significant difference in age, gender, disease duration, side of KOA, and Kellgren-Lawrence grading between groups (P>0.05). The pain and function of knee joint were assessed by visual analogue scale (VAS) score, Lequesne Index score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint activity before treatment and at 1, 3, and 5 weeks after the first treatment. Results: There were significant differences in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between pre- and post-treatment in all groups (P<0.05). VAS score, Lequesne Index score, and WOMAC score gradually decreased with the prolongation of treatment time (P<0.05); but there was no significant difference in knee joint activity between different time points (P>0.05). There was no significant difference in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between groups before treatment (P>0.05); the scores of group C were superior to groups A and B (P< 0.05) at different time points after treatment; while the knee joint activities of 3 groups were similar (P>0.05). Conclusion: The extracorporeal shock wave therapy combined with PRP injection can relieve the pain synergistically for KOA.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho , Plasma Rico em Plaquetas , Humanos , Ácido Hialurônico , Injeções Intra-Articulares , Osteoartrite do Joelho/terapia , Estudos Prospectivos , Resultado do Tratamento
2.
Zhonghua Yi Xue Za Zhi ; 99(41): 3255-3259, 2019 Nov 05.
Artigo em Chinês | MEDLINE | ID: mdl-31694122

RESUMO

Objective: To explore whether exercise could influence outcomes and improve life quality of patients with knee osteoarthritis. Methods: This study included 210 patients diagnosed with knee osteoarthritis from October to December 2018 in Shijiazhuang Derui Exercise Rehabilitation Medical Center. These patients were divided into two groups with random number table: experiment and control group. Patients in experimental group got exercise rehabilitation training and routine therapy,but patients in control group got routine treatment only that included physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs). We applied different kinds of measure to follow-up these patients,which included Lysholm scale, the Western Ontario and McMaster Osteoarthritis Index (WOMAC), SF-36 life quality questionnaire, and knee range of motion.The degree of pain and symptoms and the knee function and the quality of life in the two groups were recorded too. Paired sample t test was used to compare the data between the two groups. Results: There were 105 patients in each group, but 13 cases (12.4%) in experimental group and 6 patients (5.7%) in control group were lost,respectively.All the patients were followed up for (12.0±2.3) weeks. There was no significant differences in age, body mass index, gender between the two groups. At the final follow-up, the WOMAC score in the experiment group was 84.4±6.8, and it was 108.3±1.7 in the control group (t=-4.71, P<0.05);the Lysholm score of the experimental group was 65.5±4.7, and it was 41.2±1.4 in the control group (t=7.29, P<0.05); the knee range of motion in the experiment group and control group was 121°±7° and 114°±3°, respectively (t=1.83, P<0.05); the SF-36 score in the two groups was 90.0±2.8 and 75.6±1.5, respectively (t=6.15, P<0.05). Conclusion: Exercise rehabilitation plus routine therapy for patients with knee osteoarthritis can effectively improve outcome, promote functional recovery and improve quality of life.


Assuntos
Terapia por Exercício , Osteoartrite do Joelho , Humanos , Articulação do Joelho , Osteoartrite do Joelho/terapia , Qualidade de Vida , Amplitude de Movimento Articular , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(45): e17843, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702640

RESUMO

BACKGROUND: Acupuncture therapy is frequently used to treat Knee Osteoarthritis (KOA) in clinic, and usually used local acupoints near the diseased knees as therapeutic targets. Some local acupoints appeared sensitization phenomenon which was called sensitized acupoints, which were regarded as important therapeutic targets to get better therapeutic effect on clinic. Therefore, it is necessary to explore the biological basis of acupoint sensitization. Meanwhile, there is a lack of an analysis of the metabolism for sensitized acupoints in KOA patients. Considering that acupuncture effect could be multi-targeted, omics (such as metabolomics) may be a useful method to reveal the relationship between sensitized acupoints and clinical efficacy of acupuncture. METHODS AND ANALYSIS: This study is a parallel design trial. Thirty KOA patients and 30 healthy volunteers will be recruited in this study. Mechanical pain threshold will be measured by Electron Von frey in order to confirm the highest sensitized acupoints. Then collect tissue fluid from the highest sensitized acupoints by micro dialysis technical, then apply electro-acupuncture method on the highest sensitized acupoints to treat KOA patients, after 20 sessions treatments, measure and collect again. Liquid chromatography-tandem mass spectrometry method will be used to analyze the metabonomics of dialysate. RESULTS: This study will provide a high-quality evidence to reveal the local molecular mechanism of acupuncture sensitized acupoints for patient with KOA. CONCLUSION: This study will provide up-date evidence of whether acupuncture sensitized acupoints have local molecular mechanism for KOA. TRIAL REGISTRATION NUMBER: NCT03599180 (24 Jul. 2018).


Assuntos
Terapia por Acupuntura/métodos , Exsudatos e Transudatos/química , Metabolômica/métodos , Osteoartrite do Joelho/terapia , Pontos de Acupuntura , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Microdiálise , Pessoa de Meia-Idade , Osteoartrite do Joelho/metabolismo , Projetos Piloto
4.
Medicine (Baltimore) ; 98(45): e17880, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702659

RESUMO

BACKGROUND: Osteoarthritis (OA) is a degenerative disease that not only causes knee pain in older adults, but also has an adverse effect on walking. Therefore, intervention for older patients with OA is important. To investigate the immediate effects of kinesiology taping (KT) on the pain and gait function of the older adults with knee OA. METHODS: This study enrolled 10 older adults individuals living in the community who were diagnosed with knee OA. All participants were assessed for knee pain, walking ability, and balance before and after application of knee KT. Knee pain was assessed in resting and walking conditions using the visual analog scale. Walking and balance were assessed using a 10-m walking test and a timed up and go test. RESULTS: In the present study, KT significantly improved gait and balance with reduction in knee pain during walking than non-KT (P < .05). CONCLUSIONS: This study demonstrated that knee KT has a positive effect on pain reduction and walking and balance ability of the older adults with OA. Therefore, this study suggests that KT can be used as an intervention to relieve knee pain and aid walking and balance ability in the older adult.


Assuntos
Fita Atlética , Marcha/fisiologia , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Idoso , Estudos Controlados Antes e Depois , Teste de Esforço/métodos , Humanos , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Resultado do Tratamento , Escala Visual Analógica
5.
Zhongguo Gu Shang ; 32(9): 842-845, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615183

RESUMO

OBJECTIVE: To observe the clinical effect of six-step manipulation combined with extracorporeal shock wave in the treatment of knee osteoarthritis. METHODS: Seventy-six patients with KOA from December 2016 to June 2018 were divided into control group and treatment group, 38 in each group. The patients in the control group were treated with oral medicine combined with extracorporeal shock wave therapy, while the patients in the treatment group were treated with six-step manipulation combined with shock wave therapy. The VAS score, WOMAC score and clinical efficacy of the two groups were compared before treatment, 1 day, 1 month and 6 months after treatment. RESULTS: There was no significant difference in VAS score and WOMAC score between the two groups before treatment(P>0.05). VAS score and WOMAC score in treatment group were significantly lower than those in control group at 1 day, 1 month and 6 months after treatment, and the difference was statistically significant(P<0.05). CONCLUSIONS: Six-step manipulation combined with extracorporeal shock wave therapy can significantly alleviate pain and improve knee function in patients with knee osteoarthritis, and the clinical effect is obvious.


Assuntos
Terapia por Acupuntura , Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho , Humanos , Articulação do Joelho , Osteoartrite do Joelho/terapia , Resultado do Tratamento
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1446-1451, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650764

RESUMO

Objective: To review the advances in utilizing paracrine effect of stem cells in knee osteoarthritis (OA) treatment. Methods: The researches in applying stem cells derived conditioned medium, extracellular matrix, exosomes, and microvesicles in knee OA treatment and cartilage repair were reviewed and analyzed. Results: The satisfying outcomes of using different products of stem cells paracrine effect in knee OA condition as well as cartilage defect is revealed in studies in vitro and in vivo. The mechanism including suppressing the intraarticular inflammation, the apoptosis of chondrocytes, and the degradation of cartilage matrix, while enhancing the synthesis of cartilage matrix, the differentiation of in-situ stem cells into chondrocytes and the migration to the affected area. The effectiveness can be further improved supplemented with the tissue engineering methods or gene modification. Conclusion: Compared with the traditional stem cell therapy, applying the products from paracrine effect of stem cells in knee OA treatment is more economical and safer, presenting great potential in clinical practice.


Assuntos
Cartilagem Articular , Células-Tronco Mesenquimais , Osteoartrite do Joelho/terapia , Cartilagem , Condrócitos , Humanos
7.
Zhongguo Zhen Jiu ; 39(10): 1081-6, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31621261

RESUMO

OBJECTIVE: To explore the action mechanism of electroacupuncture (EA) for knee osteoarthritis (KOA) based on Wnt/beta-catenin (Wnt/ß-catenin) signaling pathway. METHODS: Ten rats were randomly selected into a sham-operation group among 50 male 2-month-old SD rats, and the KOA model was established in the remaining 40 rats by modified Hulth method. Four weeks after the model establishment, the rats were randomly divided into a model group, an experimental A group, an experimental B group and an experimental C group, 10 rats in each group. The rats in the sham-operation group and model group did not receive any intervention. The rats in the experimental A group were treated with EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) for 15 min. The rats in the experimental B group were treated with EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) for 30 min. The rats in the experimental C group were treated with EA at non-acupoint for 15 min. EA intervention was given once a day, five times a week, and totally 12-week treatment was given. After 12 weeks, the knee cartilage tissues were stained and the morphological changes were observed under light microscopy; the severity of cartilage degeneration was evaluated by modified Mankin's score; the content of interleukin-1ß (IL-1ß) in synovium tissues was detected by ELISA method; the content of Wnt-4, ß-catenin and matrix metalloprotein-13 (MMP-13) in cartilage tissues was detected by Western blot method. RESULTS: Compared with the sham-operation group, in the model group the morphology and structure of cartilage were disordered, the number of cells was significantly reduced, the matrix was decontaminated and tidal line was incomplete; the Mankin's score was significantly increased (P<0.01), the content of IL-1ß in synovium tissues were significantly increased (P<0.01), and the expressions of Wnt-4, ß-catenin and MMP-13 at protein level were significantly increased (P<0.01). Compared with the model group, in the experimental A group and experimental B group the morphology and structure of cartilage were more orderly, the number of cells was increased, the matrix staining was deepened and the tidal line was more complete; Mankin's scores were decreased significantly (P<0.01); the contents of IL-1ß in synovium tissues were decreased significantly (P<0.01), and the expressions of Wnt-4, ß-catenin and MMP-13 at protein level were decreased significantly (P<0.01). Compared with the model group, no improvement was observed in the experimental C group. Compared with the experimental A group, in the experimental C group the morphology and structure of cartilage were disordered, the number of cells was significantly reduced, the matrix was decontaminated and the tidal line was incomplete; Mankin's score was significantly increased (P<0.01), the content of IL-1ß in synovium tissues was significantly increased (P<0.01), and the expressions of Wnt-4, ß-catenin and MMP-13 at protein level were significantly increased (P<0.01). The morphological structure of cartilage in the experimental B group was similar to that in the experimental A group, and there was no significant difference in Mankin's score, IL-1ß content in synovium tissues and the expressions of Wnt-4, ß- catenin and MMP-13 at protein level between the two groups (P>0.05). CONCLUSION: EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) may reduce the expression of MMP-13 and the production of inflammatory factor IL-1ß through Wnt/ß-catenin signaling pathway, thus inhibit the degradation of cartilage matrix and the apoptosis of chondrocyte, and improve the morphology and structure of cartilage.


Assuntos
Cartilagem Articular/metabolismo , Eletroacupuntura , Osteoartrite do Joelho , Via de Sinalização Wnt , Animais , Humanos , Masculino , Osteoartrite do Joelho/terapia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Transdução de Sinais
8.
Medicine (Baltimore) ; 98(39): e17292, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574849

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is the most common form of arthritis, leading to pain disability in seniors and increased health care utilization. Acupotomy has been widely used to treat KOA. But its efficiency has not been scientifically and methodically evaluated. The aim of this study is to evaluate the efficacy and safety of acupotomy for the treatment of patients with KOA. METHODS: Relevant studies will be searched from the databases of PubMed, EMBASE, Cochrane Library, China Knowledge Resource Integrated Database, Weipu Database for Chinese Technical Periodicals, SinoMed, and Wanfang Database from their inception to June 10, 2019. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. RESULTS: The systematic review will provide high-quality evidence to assess the efficacy and safety of acupotomy for KOA by pain, stiffness, and dysfunction of knee joint, and quality of life, as well as adverse events. CONCLUSION: The systematic review will provide evidence to assess the effectiveness and safety of acupotomy therapy for KOA patients. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019132082.


Assuntos
Terapia por Acupuntura/métodos , Osteoartrite do Joelho/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Qualidade de Vida , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
9.
Pain Res Manag ; 2019: 4867904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565109

RESUMO

Local bone denervation by magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool for alleviation of pain in patients with painful bone metastasis (BM). Considering the underlying mechanism of pain alleviation, MRgFUS might be effective for various bone and joint diseases associated with local tenderness. This study was conducted to clarify the therapeutic effect of focused ultrasound in patients with various painful bone and joint diseases that are associated with local tenderness. Ten patients with BM, 11 patients with lumbar facet joint osteoarthritis (L-OA), and 19 patients with knee osteoarthritis (K-OA) were included. MRgFUS treatment was applied to the bone surface with real-time temperature monitoring at the target sites. Pain intensity was assessed using a 100 mm numerical rating scale (NRS) at various time points. Pressure pain threshold (PPT) was evaluated on the sonication area and control sites. Compared to baseline, the pain NRS scores significantly decreased in all groups 1 month after treatment, and PPT at the treated sites significantly increased in all groups 3 months after treatment. The percentage of patients who showed a ≥ 50% decrease in pain NRS scores at 1 month after treatment was 80% in BM, 64% in L-OA, and 78% in K-OA groups. PPTs were significantly higher after treatment at all evaluation time points. This study indicated that MRgFUS is effective in reducing pressure pain at the site of most severe tenderness in patients with painful bone and joint diseases. Treatment response was comparable between patients with BM, L-OA, and K-OA.


Assuntos
Dor do Câncer/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/terapia , Osteoartrite da Coluna Vertebral/terapia , Idoso , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite da Coluna Vertebral/complicações
10.
Medicine (Baltimore) ; 98(37): e17168, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517869

RESUMO

BACKGROUND: Functional limitations and pain are common presenting complaints for people suffering from knee osteoarthritis. Wedge insole can be sued for treatment of knee osteoarthritis. Hence, we conducted a systematic review and meta-analysis to explicit the efficacy of wedge insole in the treatment of knee osteoarthritis. METHODS: A systematic literature search for studies will be performed in MEDLINE, Embase, the Chinese National Knowledge Infrastructure Database (CNKI), Cochrane Library, Web of Science. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. Funnel plot will be used to assess the reporting bias. And the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3. RESULTS: This systematic review and meta-analysis will provide a synthesis of evidences for wedge insole on knee osteoarthritis. CONCLUSION: The conclusion of this study will provide recommendations to assess effectiveness of exercise on knee osteoarthritis, which may further guide clinical practice. PROSPERO REGISTRATION NUMBER: CRD42018096804.


Assuntos
Órtoses do Pé , Metanálise como Assunto , Osteoartrite do Joelho/terapia , Revisão Sistemática como Assunto , Humanos
11.
Medicine (Baltimore) ; 98(36): e17051, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490401

RESUMO

BACKGROUND: Knee osteoarthritis (KOA), a common clinical chronic osteoarthropathy, has adverse effects on the working ability and life quality of patients. At present, acupotomy and nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely applied on KOA in China and has achieved satisfactory results. However, there is no systematic review comparing the effectiveness of these two therapies for KOA. Therefore, this study will assess the efficacy and safety of acupotomy in treating KOA. METHODS AND ANALYSIS: Several databases including CNKI, Wanfang Database, CBM, VIP, PubMed, Cochrane library, Web of Science, and Embase will be used by two independent researchers to search the related clinical RCTs about acupotomy therapy for KOA patients until May 2019. Subsequently, meta-analysis will be conducted by using Review Manager 5.3, and the related data will be analyzed by using the method for GRADE. The continuous data will be presented as the WMD or SMD with 95% CI, while dichotomous data will be shown as the RR with 95% CI. CONCLUSION: Our results review will provide evidence to determine whether acupotomy can achieve the effect of NSAIDs, or whether it has advantages and safety compared with NSAIDs for patients with KOA. ETHICS AND DISSEMINATION: This study will not involve personal information. The ethical approval will not be required. This systematic review will be disseminated electronically through a peer-reviewed journal or international conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019129089.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Metanálise como Assunto , Revisão Sistemática como Assunto
13.
Zhongguo Zhen Jiu ; 39(8): 799-803, 2019 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-31397121

RESUMO

OBJECTIVE: To compare the clinical effect between warming acupuncture combined with moxibustion at Yongquan (KI 1) and simple warming acupuncture for knee osteoarthritis with kidney-marrow deficiency. METHODS: A total of 66 patients of knee osteoarthritis with kidney-marrow deficiency were randomized into an observation group and a control group, 33 cases in each one. Warming acupuncture was applied at Neixiyan (EX-LE 4), Dubi (ST 35), Zusanli (ST 36) and Xuanzhong (GB 39) on the affected side in both of the groups. In the observation group, mild moxibustion at bilateral Yongquan (KI 1) was adopted additionally. Each treatment lasted for 30 min, 3 times a week (once every other day), and the consecutive 6 weeks of treatment were required. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (such as joint pain, stiffness and physical function), the amount of joint effusion and the serum contents of interleukin-1ß(IL-1ß), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) were observed before and after treatment in the two groups. RESULTS: The total effective rate in the observation group was 93.3% (28/30), which was superior to 87.1% (27/30) in the control group (P<0.05). Compared before treatment, the pain scores, stiffness scores, physical function scores, the amount of joint effusion and the contents of IL-1ß, TNF-α and hs-CRP after treatment were significantly reduced in the two groups (P<0.05), and the improvements of these indices in the observation group were superior to the control group (P<0.05). CONCLUSION: Warming acupuncture combined with moxibustion at Yongquan (KI 1) can improve joint function, reduce the amount of joint effusion and the contents of inflammatory response indices for knee osteoarthritis with kidney-marrow deficiency. The therapeutic effect of warming acupuncture combined with moxibustion at Yongquan (KI 1) is better than simple warming acupuncture.


Assuntos
Terapia por Acupuntura , Moxibustão , Osteoartrite do Joelho/terapia , Pontos de Acupuntura , Medula Óssea , Humanos , Resultado do Tratamento
14.
Zhongguo Zhen Jiu ; 39(8): 804-8, 2019 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-31397122

RESUMO

OBJECTIVE: To compare the therapeutic effect between thunder-fire moxibustion combined with external applicaion of Shuangbai powder and thunder-fire moxibustion alone for mild and moderate knee osteoarthritis. METHODS: A total of 70 patients with mild and moderate knee osteoarthritis were randomly divided into an observation group and a control group, 35 cases in each group. In the observation group, thunder-fire moxibustion combined with external applicaion of Shuangbai powder were applied, Thunder-fire moxibustion was applied at Xuehai (SP 10), Liangqiu (ST 34), Neixiyan (EX-LE 4), Yanglingquan (GB 34) and ashi point, external applicaion of Shuangbai powder was given to the affected knee after the treatment of thunder-fire moxibustion. Simple thunder-fire moxibustion was given in the control group. All patients in the two groups were treated once a day, 7 days as one course and the consecutive 4 courses were required, with an interval of 1 day between courses. Before and after treatment, the visual analogue scale (VAS) score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were used to assessed knee pain, stiffness and physical function in the two groups. In addition, the efficacy was evaluated. RESULTS: Compared before treatment, the VAS scores, total scores of WOMAC, pain scores, stiffness scores and physical function scores were reduced after treatment in the two groups (P<0.01), and the scores in the observation group were significantly lower than those in the control group (P<0.01, P<0.05). The total effective rate was 97.0% (32/33) in the observation group, which was superior to 91.2% (31/34) in the control group (P<0.05). CONCLUSION: Thunder-fire moxibustion combined with external applicaion of Shuangbai powder are superior to simple thunder-fire moxibustion in improving the symptoms and delaying the development of the disease for mild and moderate knee osteoarthritis.


Assuntos
Moxibustão , Osteoartrite do Joelho/terapia , Pontos de Acupuntura , Humanos , Articulação do Joelho , Resultado do Tratamento
15.
Orthop Clin North Am ; 50(4): 415-423, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466658

RESUMO

There is a growing interest in cell therapy for knee osteoarthritis. This study systematically reviews the current status of cell-based therapies. The authors review treatment modalities, clinical outcomes, and the economics of cell therapy. Inclusion criteria were articles containing cellular therapy, platelet-rich plasma, and knee osteoarthritis in the title. Letters, editorial material, abstracts not published, and manuscripts with incomplete data were excluded. Forty-two articles met these inclusion criteria and were critically reviewed. Cell-based therapy holds promise as a means of restoring deficient local cartilage cell populations. There is no evidence-based information for the use of cell-based therapies in knee osteoarthritis.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/economia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Osteoartrite do Joelho/terapia , Terapia Baseada em Transplante de Células e Tecidos/normas , Análise Custo-Benefício , Política de Saúde , Humanos , Plasma Rico em Plaquetas/citologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transplante de Células-Tronco , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration
16.
Int J Nurs Pract ; 25(5): e12772, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31436359

RESUMO

AIM: This study aimed to determine the effect of application of superficial local heat and a home exercise program on pain and function levels to patients with bilateral knee osteoarthritis. METHODS: This study was conducted in Turkey between January 2014 and February 2015. The sample group of the study consisted of 62 patients with osteoarthritis; 15 assigned to heat application, 15 to exercise, 15 to exercise after heat application, and 17 for the control group. While the patients in the control group received routine treatment only, the patients in the intervention group were treated with heat application, exercise, or exercise after heat application, suggested for 5 days a week for 4 weeks in addition to routine treatment. RESULTS: In this study, all of the intervention groups had decreases in Visual Analogue Scale Pain and Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and function scores when compared with the control group. It was found that this decrease in Visual Analogue Scale Pain and Western Ontario and McMaster Universities Osteoarthritis Index scores was mostly in the exercise group, but this condition was not statistically significant. CONCLUSIONS: As a result, it is recommended that nurses train patients with osteoarthritis on heat application and home exercises and encourage them to apply these practices.


Assuntos
Terapia por Exercício , Temperatura Alta/uso terapêutico , Osteoartrite do Joelho/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Escala Visual Analógica
17.
Int J Clin Pract ; 73(11): e13402, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408240

RESUMO

INTRODUCTION: Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry. OBJECTIVE: To provide a synthesis of the efficacy of PRP for different clinical situations. METHODS: Systematic searches were carried out in MEDLINE, Embase, Cochrane Library and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. RESULTS: One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. CONCLUSION: There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.


Assuntos
Plasma Rico em Plaquetas , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Osteoartrite do Joelho/terapia , Lesões dos Tecidos Moles/terapia , Cicatrização
18.
IEEE Int Conf Rehabil Robot ; 2019: 374-379, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374658

RESUMO

Knee osteoarthritis patients have pain in their knee and it can become difficult to walk depending on the progress of symptoms. After performing chondrocyte implantation, it is necessary to reduce the load on the knee joint until the implanted cartilage is integrated. The purposes of this study were to develop a device that enables the user to walk and reduced the weight on the knee joint and to confirm basic performance of the device through experiments. The device was composed of a seat for supporting the body weight of the user, a prosthetic knee, and the floor reaction force sensor shoes. Experiments were conducted to confirm the basic performance of the device. As a result, an able-bodied participant who wore the device was able to walk while unloading two-thirds of their body weight onto their knee. As a result of gait analysis, it was found that the gait did not change significantly even when the device was worn.


Assuntos
Desenho de Equipamento , Exoesqueleto Energizado , Articulação do Joelho/fisiopatologia , Aparelhos Ortopédicos , Osteoartrite do Joelho/fisiopatologia , Caminhada , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia , Suporte de Carga
19.
IEEE Int Conf Rehabil Robot ; 2019: 931-937, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374749

RESUMO

Knee osteoarthritis (KOA) is a painful and debilitating condition that is associated with mechanical loading of the knee joint. Numerous conservative treatment strategies have been developed to delay time to total joint replacement. Unloader braces are commonly prescribed for medial uni-compartmental KOA, however their evidence of efficacy is inconclusive and limited by user compliance. Typical commercial braces transfer load from the medial knee compartment to the lateral knee compartment by applying a continuous brace abduction moment (BAM). We propose that brace utilization and effectiveness could be improved with a robotic device that intelligently modulates BAM in real time over the course of a step, day, and year to better protect the knee joint, improve pain relief, and increase comfort. To this end, we developed a robotic unloader knee brace ABLE (active brace for laboratory exploration) to flexibly emulate and explore different active and passive brace behaviors that may be more efficacious than traditional braces. The system is capable of modulating BAM within each step per researcher defined unloading profiles. ABLE was realized as a lightweight orthosis driven by an off-board system containing a servo motor, drive, real-time controller, and host PC. Frequency response and intra-step trajectory tracking during level-ground walking were evaluated in a single healthy human subject test to verify system performance. The system tracked BAM vs percent gait cycle trajectories with a root mean square error of 0.18 to 0.58 Nm for conditions varying in walking speed, 85-115% nominal, and trajectory peak BAM, 2.7 to 8.1 Nm. Biomechanical and subjective outcomes will be evaluated next for KOA patients to investigate how novel robotic brace operation affects pain relief, comfort, and KOA progression.


Assuntos
Braquetes , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , Desenho de Prótese , Robótica , Algoritmos , Fenômenos Biomecânicos , Tratamento Conservador , Marcha/fisiologia , Humanos , Masculino , Suporte de Carga
20.
Knee ; 26(5): 1032-1040, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375446

RESUMO

AIM: Platelet Rich Plasma (PRP) is an emerging therapy for knee osteoarthritis (KOA). Studies have evaluated the effectiveness of intra-articular PRP, which ignores extra-articular tissue dysfunction and may provide incomplete treatment of KOA. The study aimed to pilot test a leukocyte-rich (mononuclear cells) PRP injection protocol for primary KOA, which consisted of single intra-articular injection and extra-articular injections on the medial coronary and medial collateral ligaments. METHODS: A prospective 26-week single-arm uncontrolled feasibility pilot study. Patients (N = 12) with primary KOA as defined by the American Rheumatology Association, with moderate to severe medial knee pain which failed conservative management, were recruited in a university primary care clinic and received a single session of PRP injection in week 1. The primary outcome was the feasibility of the protocol at 26 weeks as defined by rates of recruitment, compliance, retention, dropout, side effects or adverse events; and treatment satisfaction. Secondary outcomes included the Western Ontario McMaster University Osteoarthritis Index, the Intermittent and Constant Osteoarthritis Pain total and subscales, objective physical function tests and EuroQol-5D. RESULTS: Twelve of 40 potential patients were recruited in 3 months period (recruitment rate 30%, x2 = 3.33, P = 0.068). All participants adhered to the protocol and completed the follow up assessment with no dropouts (dropout rate 0%, X2= 2.67, P = 0.103). Satisfaction was high; no related adverse events were reported. Most secondary outcomes showed statistically significant improvement. CONCLUSIONS: Concomitant intra-articular and extra-articular PRP injections were feasible and produced preliminary favourable outcomes.


Assuntos
Articulação do Joelho/cirurgia , Osteoartrite do Joelho/terapia , Plasma Rico em Plaquetas , Adulto , Estudos de Viabilidade , Feminino , Humanos , Injeções , Injeções Intra-Articulares , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
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